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349 thoughts on “Chiropractors as Family Doctors? No Way!

  1. nwtk2007 says:

    Schools are offering studies in all things for consideration ass they think that patients are benefited by things not yet or which may never be supported by science. Its a quality of life philosophy which basically promotes the idea that if a person feels they are benefited then it is a good thing. As with anything, real or not, it can be exploited just as big corp is exploiting the entire population of the US even as we speak by sucking us dry economically while lining their pockets at all of our expense. And it doesn’t make anyone feel any better about anything either.

  2. And that just about sums up chiropractic. Thank you and good night!

    … Now we’re expected to believe that uncompetitive students with 2.5 GPAs and no college degree learn everything in four years, including a massive amount of quackery (almost everything advertised on your school was quackery), but can discern fact from fiction (“oh sure all that’s fake, but yeah I can adjust your spine and that’s real. Wink wink nudge nudge”), and are better trained and more skilled than PTs who are smarter, more competitive, and don’t waste precious academic time on quackery, X-ray taking, history lessons, marketing, advertising, and, oh yeah, subluxations.

    Substandard care.

  3. nwtk2007 says:

    As was stated by scott, its getting into the medical schools too.

    And skeptical, you need to get off your high-horse. GPA is a poor indicator of intelligence and ability. Additionally, your rigidity coupled with your ego is going to, sooner or later, hurt a patient in the worst possible way. It’ll be a hard lesson for you to learn but you WILL learn it. And stop watching House why don’t you.

  4. …. precisely what someone who performed poorly in school and pursued substandard education would say.

    (Strange House reference, haven’t watched it since sometime in its first season.)

  5. nwtk2007 says:

    My comment on GPA is based upon many years of teaching. I still teach at a local college and I certainly did perform poorly in HS however. Very bored.

    You would do well to heed my warning.

  6. Is that opinion based on your vast clinical experience, chiropractor?

    (I appreciate that you absolutely cannot defend your profession nor your education riddled with pure quackery, so now you have started down this pathway that I have a big ego – because I’ve humiliated your school and profession – and that patients are now at risk. Spare me, this is ridiculous.)

  7. jhawk says:

    @skepticalhealth

    “Your school gives barely any information on its chiropractic program.” It shows everything a entering student would need to know.

    “It doesn’t give an overview of its philosophy” yes it does. portal of entry msk provider is its “philosophy”

    “the techniques you’ll learn, or anything.” what like BEST, NSA, NUCCA you have been mentioning. Did you stop to think maybe it’s becasue they are not offered there.

    “You don’t seem to get that you should not be ordering or taking x-rays or other imaging modalities. You are not capable (knowledge, skill, license) to treat any condition that is diagnosed with imaging.”

    You are wrong again. Many small rotator cuff and labral tears are mangaged quite nicely with conservative care.

    ” If a *client* of yours is non-responsive to your treatment, then send them to a real medical doctor. Do not delay their treatment any longer or further.”

    Thanks for the advice but I will let my experience and training in msk medicine guide me here.

    ” Now we’re expected to believe that uncompetitive students with 2.5 GPAs and no college degree learn everything in four years”

    My school is minimum of 3.0 gpa. No college degree is required but you have to have at least 90 hours of which many are science pre-req’s. The majority of students have undergrad degrees. These are minimum requirements. A quick glance at U Washington Medical school there is no degree requirement- only the prereq courses.

  8. marcus welby says:

    Please do not make any comparison of the education of chiropractors and PTs. Having taught in a PT program from 1984-1991, I am well aware that the grade point ave. as an undergrad to get into PT school is very highly selective, the PT students don’t spend time on marketing and mysticism, and PTs learn how to do gait training, use of crutches, walkers, wheelchairs and other adaptive devices, rehab in multiple scenarios: CP and other neuromuscular diseases, strokes, amputations, artificial limbs, recovery from surgery, transfers, adaptive aids at home, and the like. They are superbly selected for admission to PT programs and very well trained in a host of arenas chiropractors are ignorant of, for the most part.

  9. 100% agree with Marcus. A chiropractor practicing chiropractic is utilizing quackery. A chiropractor pretending to be a PT is providing sub-standard care. Delicense these quacks, now.

  10. Harriet Hall says:

    This thread is generating a lot of heat; the number of comments is approaching that of my article on circumcision. It’s curious in that my article did not directly attack chiropractors, only the idea that they can function as family doctors. And even the chiropractic commenters seem to agree that they can’t fill that role.

  11. EricG says:

    @ HH the most amusing thing has been to watch the dialogue between SH and nwtk. it never ceases to amaze me that SH doesn’t get tired of banging his head against a wall. its threads like these that give this blog its jazz hands.

    @ SH, you’ve said exactly the same thing in countless variations to no avail, whilst nwtk just dances around and introduces all sorts of fanciful new nonsense (“hey, lets talk about my teaching career, how great my practice is, my lack of enthusiasm in high school”). you have the patience (or, sadism…can’t see your expression while you type) of a monk.

    @ nwtk – the funny thing about all of this personal experience of yours is that it CRUMBLES under the weight of compiled evidence. the FIRST thing that was said to the class in one of my undergrad psych classes was that “personal experience is notoriously unreliable.” Just out of curiosity, at what college do you teach?

    just to continue this thead in absurd directions so I can get all pedantic on the topic….GPA is among the best predictors of *performance*. up there with it, is a glowing recommendation from a respected member of whatever field you happen to be in. so, within your argument lies a straw man, because GPA is not intended to predict ability and intelligence anyway…that’s what aptitude tests are for. no one (serious) in the field of selection any longer equates the two.

    so, the whole point of bringing up GPA and med school and whatnot is that those with a high GPA are more likely to successfully handle the rigor, workload and curriculum demands of med school. whether they are innately intelligent (*snicker*) is measured elsewhere. consequently, a minimum GPA of 2.5 merely reflects “we’ll accept those who have an average amount of determination to realize their goals.”

  12. nybgrus says:

    indeed. almost any chiro related post seems to go quite nicely off the rails at some point.

    Personally, I comment extensively on these merely because I ended up becoming extremely well educated on the matter last year, when I was genuinely trying to determine the utility and validity of a DC. Needless to say I found basically none. Since I no longer have the time or desire to so thoroughly educate myself on a new topic, I relegate myself to sticking to what I know.

    Schools are offering studies in all things for consideration ass they think that patients are benefited by things not yet or which may never be supported by science.

    And the authorship and science based commentariat here would all agree that this is not acceptable.

    As was stated by scott, its getting into the medical schools too.

    And that this is doubly unacceptable.

    Besides, using the “well, he did it too!!” argument is pretty, well, bad. It clearly evinces the fact that you have nothing useful or material to say on the topic and continue to try and scrape by on BS.

  13. nybgrus says:

    @skepticalHealth:

    Yes, it is a very daunting prospect. Unlike the chiros seem to think, and especially in their wording of documents, diagnosis and management is not a right. It is foremost a responsibility, and – quite frankly – a burden, but also a privilege we decide to bear for the greater good of society. For me, it is primarily a responsibility and that is how I view it. I feel an onus to ensure that I will always, to the best of my ability, and in every way possible do the best I can by my patient at all times. That means delving deeply to understand what will actually make them better – not just what will make them feel better.

    It is a burden sometimes, because you have to bash you head against walls of obesity, hypertension, and diabetes with a smile on your face and a kindness in your speech every single time. You have to tell the acute MI or cancer patient the diagnosis and work hard to make him or her better. And you have to remember that while you are tired, just had your attending yell at you, had a fight with your girlfriend because you couldn’t make it home for dinner again, and this is your 500th lumpectomy for a Stage 1 DCIS, it is the first and scariest – and most important point to date – in your patient’s life. You have to sacrifice time from yourself, your family, your friends so you can make sure you know the right thing to do.

    It isn’t a nice little jaunt through a mere 6 or maybe 8ish years of learning random ass BS so you can then get the right to diagnose and order tests that make no sense, do interventions that either have no evidence or make no sense themselves, all so you can strut around calling yourself “doctor” and say how you rub shoulders with MDs, DOs, PTs, NPs, and however many other pointless acronyms you can throw out.

    Oh, and the TMA went very well. It was a very pleasant diabetic lady I saw in clinic on Monday. She’d actually lost a toe from an embolus, which then became infected, and the wound care nurse at home was rather bad at her job, didn’t properly check the wound vac and tied coban around her foot too tight which led to spreading infection and gangrene. So we had to take everything to avoid a BKA. The tissue remaining looked quite viable and the wound was able to be closed primarily. I spent extra time power irrigating with 12 liters of saline and then put in twice as many vertical mattress sutures to spread out the tension evenly in the hopes of avoiding flap necrosis.

  14. nwtk2007 says:

    Eric, anything I bring up, while fanciful to you, is in context of the discussion, not as a brag or to impress. Believe me, I have no need to impress MD’s, DO’s or DC’s. When you mention those items as “fanciful”, you do so out of context in just another attempt to demean.

    I am in agreement with this thread in that chiro’s should not be PCP’s and I disagree with those who say that chiro’s lack training to help patients in any way, treat, diagnose, order imaging, etc as was mentioned by the a fore mentioned. (This statement is not inclusive of the subluxation based chiro.) I have been commenting in these threads for a while now and much has been presented in terms of evidence for and against chiropractic’s effectiveness. I have found that pretty much anything presented will be shot down or simply not looked at, at all. Most of the arguments pointing out the weaknesses of the studies presented are somewhat valid but don’t totally discount the evidence or interpretations of the data.

    Interestingly, you and others have said that experience is not reliable yet it is the “experience” of those who opined that PT’s are better trained to handle musculoskeletal conditions and, I guess, rehab? I don’t discount experience but I do point out bias, and I will trust my experience on that one for sure. All too often I have seen a PT decide a patient doesn’t need treatment who later ends up in the hands of a surgeon. They are heavy into putting patients on machines with out any meaningful presence and tend to avoid contact with patients. In fact, my observation of the ones who have worked for us is that they don’t like to touch patients, strangely enough. We no longer employ them by the way. I’m sure there are many good ones out there I am just not seeing them. They also don’t like to sign their reports. They will type their names to them, but I have to constantly request a signed copy. They also love automated reports with repetitive language and all disagree with each other. But that’s just MY experience. If you can present some kind of evidence, study or some such, demonstrating the PT’s superior ability in performing exams, differentially diagnosing, case managing, etc then I’d like to see it. To imply that a DC pretends to be a PT is just too funny from my perspective although I’m sure some do. In fact, pretending to be an MD or DO is also just too funny as well.

    Finally, since its been brought up yet again, I teach in the Dallas County Community College System and have since the early 80′s; Bio for majors and non, microbiology, anatomy and physiology for majors and allied health (the ones who become nurses, radiologists, PT’s, etc.)

    I hope there is nothing here in this response which you deem to be fanciful or a dance of around something or another in an attempt to validate chiropractic.

  15. EricG says:

    @ Nybgrus

    hear, hear! keep up the good work and good spirits :)

  16. EricG says:

    @ nwtk

    much has been presented in terms of evidence for and against chiropractic’s effectiveness

    i think we all missed the “for” part you reference…

    you may be quick to reference jhawk’s discussion with various individuals, but that was almost exclusively devoid (i’ll refrain from absolutes in order to avoid scanning the whole thing…) of subluxation discussion and almost wholly oriented towards various manipulation techniques. which, i think it is roundly agreed, has a place in sbm. As I understand it, subluxation is the central tenent of most (all?) of the chiropractic educational systems.

    so, why nitpick? because assertion =/= much presentation

  17. EricG says:

    @ nwtk

    no, i really was just curious. i just missed it among the 200 posts. my apologies.

    as well, “manipulation techniques” should probably read something more like “discussion and treatment of mobility related issues”

  18. EricG says:

    and lastly…

    I hope there is nothing here in this response which you deem to be fanciful or a dance of around something or another in an attempt to validate chiropractic.

    i think it would be a great relief to everyone if posting chiropractors put up the best 2 or 3 studies that validate their profession (evidence of the subluxation would be nice). then, if the information put forth does not meet the criteria that every other scientific discipline on the planet must abide by, just quit insisting that it does…or make excuses for it…or assert that its beyond someone’s understanding or…that MDs hurt people too….or that people are mean when they post or…the evidence just isn’t there yet….or….whatever.

    if i seriously stated the following:

    “there is a 900 pound diamond burried in my backyard that modern science just isn’t sophisticated enough to unearth”

    I would be treated with the same contempt.

    I think Nygbrus’s comment ought to be repeated:

    …can then get the right to diagnose and order tests that…

    this is true under any circumstances no matter what letters are behind your name. DCs have yet to earn the privilege to undertake that responsibility…as per the evidence they have yet to produce…

  19. @nwtk, I have trouble believing that you teach the classes you listed. I would believe that you teach the *labs* for the classes that you listed, but not the classes themselves. I would not think that any college, even a community college, would hire a chiropractor to teach those classes. In every institution I’ve ever been in, people teaching those classes have either a Masters or a PhD. I do not think that your D.C. would be considered accredited by the DOE. If you do teach those classes, you must have known someone at the institution to get in with them. Further, I feel bad for the students because you do not come from a scientific background, and have not had any rigorous education in those classes that would qualify you to teach them. Sucks to be them.

  20. Yeah, and I worry about D.C.s with their ordering of tests and imaging. In real medicine, we have a standard of care, and we have a reason and a plan when we order any test, and we specifically and deliberately, to the point of being annoyingly frustrating, do or don’t order certain tests. We don’t just order a bunch of crap willy nilly and see if we find something. That’s not medicine, that’s guessing.

    Chiropractors, on the other hand, will x-ray any and everything, for no reason whatsoever, and then make up findings on x-rays. The worse was an x-ray of a kid who the chiropractor told the family had “shards of bones all along his femoral head” and told the parents that the kid (mentally handicapped) was probably being abused at school. On x-ray it was simply growth plates. Must have been a Parker graduate. But why would he x-ray the patient in the first place? If he saw a fracture in the femur he could do nothing to treat it. He would needlessly be exposing the kid to radiation. Again, they have zero ability to treat *anything* that is diagnosed with x-ray, and them seeing a patient that may have a fracture or has suffered trauma without being worked up by a legitimate doctor is completely inappropriate and a danger to patients.

    Hopefully chiropractic is dying, practices are closing, and these idiots are defaulting on their loans.

    If it isn’t bad enough that there are institutions open that are graduating these brainless anti-medicine drones, we can’t forget about the fact that a lot of these institutions are graduating naturopathic “doctors” too. Boy do they have a big surprise coming to them, when they find out that they are absolutely 100% useless and have no role anywhere under any circumstance.

  21. * re: accreditation, I don’t know enough about academia to know the specific terminology I’m trying to use. While your school is I’m sure accredited by the chiropractic accreditation agency, and the agency is recognized by the DOE, I wouldn’t think that your college would recognize a degree from the chiropractic accreditation agency as being a suitable “substitute” for a PhD or Masters. Especially if you don’t have an undergrad.

    Damn, I feel bad for those students. I can’t imagine the quackery you spread on them. I almost support eugenics again. :)

  22. nwtk2007 says:

    You’re so the nice guy but I won’t destroy your ego further such that you feel more need to lash out. Don’t worry, someone will get you over yourself.

    Not sure what you mean by “your school”. The chiro college is accredited with SACS I think, not sure. The school I teach at won’t accept the DC as adequate for teaching there, although they did in the past. I have a masters in molecular bio from UTD so I’m good.

    Yes, I spread utter quackery everywhere rampantly. I often point them in this direction to observe the mentality of those they might be working with later as nurses, radiologists, PT’s, etc as well. Mucho fun. Always corroborated by those already in the profession.

  23. I think that your obsession with my “ego” is a little weird. All you’ve done is reinforce everything that I already thought I knew about chiropractic: the schools are riddled with quackery and advertise complete BS on their websites, the students are “average” at best, and they inappropriately handle patients due to their complete lack of legitimate clinical knowledge. I’d hazard that, quackery aside, the biggest problem with chiropractic is the blind leading the blind. You can’t learn anything if the person who is teaching you is equally unprepared and equally as incompetent.

  24. nybgrus says:

    …and we have a reason and a plan when we order any test, and we specifically and deliberately, to the point of being annoyingly frustrating, do or don’t order certain tests..

    That is a very important point. Too many poor medical doctors shotgun and that is distinctly considered poor practice. I personally get on people about that.

    A chiropractor ordering an xray can never be good practice.

    The best thing an xray can do is demonstrate to a chiro what they can’t do. In other words, they formulate an idea of what might be the case, and then would have to xray to make sure there isn’t a fracture and if there is (hopefully) refer on.

    A medical doctor would clinically diagnose a fracture, and use the xray to confirm or disconfirm this and then refer to an orthopedist as necessary. Every PCP is able to treat some range of fractures.

    Beyond that aspect, there is absolutely no role in xrays for DCs. Nor any other lab tests.

  25. nybgrus says:

    @EricG:

    Thanks! It is always a tough road, with ups and downs, but always worth it in the end.

  26. nobs says:

    Skepticalhealth posts/claims:
    “The worse was an x-ray of a kid who the chiropractor told the family had “shards of bones all along his femoral head” and told the parents that the kid (mentally handicapped) was probably being abused at school. On x-ray it was simply growth plates…..’

    Please cite the source your above claim

    Thank-you in advance

  27. nwtk2007 says:

    You’re wasting your time nobs. But it is a fact that the only miss-read x-rays I have EVER seen were miss-read by an MD. Isn’t that interesting? Yet we are being told that no good can come from a chiropractor x-raying. Hmm. What a maroon.

    The absolute funniest was the MD at the neighborhood hospital who called my daughters radius an ulna and her ulna a radius. This guy, by the way, had been awarded doctor of the year on more than one occasion in that hospitals PA. My HS educated wife even knew the difference. She signaled me not to say anything and asked that I just look for myself to make sure there was no fracture. Had there been I would have had a very embarrassed MD on my hands indeed. I shouldn’t have but I let him off.

    Not that chiro’s can fix a fracture but when folks come to me AFTER being seen by the docs at the hospital, having been told that they are fine and only have a strain, I do feel obligated to take a closer look now. I base this on my experience, which apparently is not to be trusted according to many on this blog. Many thanks from the patients too who, just based upon THEIR experience, learn to trust a chiro more than an MD. And luckily, there are a plenty of local MD’s who aren’t so stupid as to over look such things and are grateful also, on behalf of the patient, for the diligence we show.

    Now for the plea that the ER doc’s are so over burdened by seeing real cases which us chiro’s are not qualified to see. How they work tirelessly, without sleep and save lives by the dozens, which of course they do.

  28. @nobs: lol, source = a concerned parent who presented with her child telling me that his chiropractor told he he had shards of bones all along his femur.

  29. @nwtk2007, I’m sure that all of us appreciate your supposed anecdotes about you being so much better than a MD at reading x-rays, because I’m sure you got a lot of training in your 2.5 GPA-required school, where you spent 4 years learning about applied kinesiology, BEST, NSA, subluxations, anatomy, physiology, marketing, chiropractic history, advertisements, taking x-rays, and reading x-rays. You don’t seem to understand that you have substandard quality of skills in multiple areas. The sad thing is that because you operate in a facility full of other poorly trained, under-achieving quacks that you wouldn’t know the difference if you did or did not see a legitimate finding on x-ray. I routinely see see supposed fractures that are just sesamoid bones, “cured” scoliosis with massive curvatures, and diagnosed scoliosis in a patient with straight spines. All from chiropractors.

    Indeed, multiple studies have found that chiropractors use X-rays unnecessarily. Studies have shown that up to 71% of patients being treated for low-back pain by chiropractors have been X-rayed by them.256 Other studies have found that up to 96% of new patients are X-rayed, and 80% of patients on follow-up visits are X-rayed by chiropractors.257

    Currently, there is no good reason for chiropractors to X-ray the spine. Many utilize X-rays to diagnose subluxations of the spine, despite the fact that the concept of subluxations is disproven and even evidence-based chiropractors no longer claim they exist.

    Experts on low-back pain uniformly agree that X-rays are usually not useful for diagnosis.258 In fact, chiropractic textbooks point out that “routine radiographic investigation of the lumbar spine should be avoided because of the radiation hazard but also because inappropriate X-ray examination contributes little to the solution of a particular problem and may even obscure it.”259

    Chiropractic guidelines recommend that X-rays are unnecessary for the management of uncomplicated acute low-back pain. Studies show that chiropractors do not adhere to these guidelines and continue to use X-rays excessively.

    Chiropractors routinely employ the use of full spine X-rays, which have been calculated to be more likely to cause cancer than detect bone cancer in the average patient.260

    In fact, high-quality systematic reviews (see “Investigations” in this chapter) have shown that chiropractors are unable to treat any condition that would diagnosed by X-ray. Therefore, it is suggested by the author that if a chiropractor suspects a condition that necessitates X-ray, the appropriate course of action should be to refer the patient to a medical doctor.

    In 1994, a survey of chiropractors in America found that 96% of new chiropractic patients are X-rayed, and 80% of patients are X-rayed on follow-up visits.261

    In 2002, a study assessed the views of chiropractors on the use of radiography (X-rays) for evaluating patients with acute low back pain. The study found that 63% of chiropractors stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week. 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low-back pain lasting less than 1 month. The study noted that the reasons given for use of radiography in this study are not supported by existing evidence. The study concluded that there appears to be a high rate of radiographic use by chiropractors which is consistent with findings in previous studies.262

    In 2008, a study examined the instructions provided at chiropractic schools worldwide on the use of spine radiography (X-rays) compared with evidence-based guidelines for low-back pain. The study found that 56% of chiropractors believed, against evidence-based guidelines, that they should Xray the lower back in the absence of “red flags” for serious disease. The study concluded that this may be responsible for chiropractic over-utilization of radiography for low back pain.263

    In 2011, a study aimed to determine how well chiropractors manage low-back pain in accordance with recommendations from an evidence-based acute low-back pain guideline. The recommendations were directed at minimizing the use of plain x-ray and encouraging the patient to stay active. The study found that 68% of chiropractors would take an X-ray even when it was not indicated, and 51% would give advice to stay active when it was indicated. The study showed a low adherence to recommendations from an evidence-based guideline for acute low-back pain.264

    References:

    256 Breen AC. “Chiropractors and the treatment of back pain.” Rheumatol Rehabil. 1977 Feb;16(1):46-53.

    257 Ernst. “Chiropractor’s use of X-rays.” The British Journal of Radiology, 71 (1998), 249-151.

    258 Deyo RA, Diehl AK, Rosenthal M. “Reducing roentgenography use: can patient expectations be altered?” Arch Int Med 1987; 147:141-5.

    259 Grieve GP. “Incidents and accidents of manipulation and allied techniques.” In: Grieve’s Modern Manual Therapy. Edinburgh: Churchill Livingstone, 1994: 679.

    260 Fickel TE. “An analysis of the carcinogenicity of full spine radiography.” ACA J Chiroprac 1986; 23:61-6.

    261 Plamindon RL. “Summary of 1994 ACA statistical study.” J Am Chiropractic Ass 1995; 32:57-63.

    262 Ammendolia C, Bombardier C, Hogg-Johnson S, Glazier R. “Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community.” J Manipulative Physiol Ther. 2002 Oct;25(8):511-20.

    263 Ammendolia C, Taylor JA, Pennick V, Côté P, Hogg-Johnson S, Bombardier C. “Adherence to radiography guidelines for low back pain: a survey of chiropractic schools worldwide.” J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):412-8.

    264 Walker et al. “Management of people with acute low-back pain.” Chiropr Man Therap. 2011 Dec 15;19(1):29.

    (By the way, I don’t know who a Miss Read, is she a friend of yours? That over-achiever 2.5 GPA is really starting to shine.)

  30. By the way, thank you for admitting you x-ray patients who are only diagnosed with a simple strain merely because you believe you are better at reading x-rays than real doctors. You’re a class act. I’m sure your patients appreciate you needlessly exposing their brain and body to radiation.

    Seriously, you quacks need to be delicensed.

  31. nybgrus says:

    But it is a fact that the only miss-read x-rays I have EVER seen were miss-read by an MD. Isn’t that interesting?

    Yep, sure is. And doesn’t jibe with reality. Everyone misreads Xrays. Sounds like a bit o’ confirmation bias to me.

    Not that chiro’s can fix a fracture but when folks come to me AFTER being seen by the docs at the hospital, having been told that they are fine and only have a strain, I do feel obligated to take a closer look now.

    Because, clearly, someone with at least 19,000 hours less training in reading radiographs can obviously and consistently give a better read.

    I base this on my experience, which apparently is not to be trusted according to many on this blog.

    It’s not just your experience that isn’t trusted. Personal experience is never trusted around these parts. That’s kinda the whole point of “science” which, as you may have noticed, is a big part of what this blog is about.

    Many thanks from the patients too who, just based upon THEIR experience, learn to trust a chiro more than an MD

    You know how you can tell your argument is very poor? When you can substitute any noun for the direct object and still have it be a true statement. Lets try it and see:

    “Many thanks from the patients too who, just based upon THEIR experience, learn to trust a homeopath more than an MD”

    “Many thanks from the patients too who, just based upon THEIR experience, learn to trust a naturopath more than an MD”

    “Many thanks from the patients too who, just based upon THEIR experience, learn to trust a reiki master more than an MD”

    “Many thanks from the patients too who, just based upon THEIR experience, learn to trust a TCM practitioner more than an MD”

    “Many thanks from the patients too who, just based upon THEIR experience, learn to trust a faith healer more than an MD”

    “Many thanks from the patients too who, just based upon THEIR experience, learn to trust a prayer more than an MD” [to the point of watching their children die needlessly, I might add]

    See you completely useless a statement it is? And how utterly pointless arguments from personal experience are? (This goes for SkepticalHealth as well – the only difference being is that he has actual science and evidence as a solid platform and anecdote as illustrative points of what is already established. Chiros, in pretty much everything they do, use the anecdote as the platform)

    And luckily, there are a plenty of local MD’s who aren’t so stupid as to over look such things and are grateful also, on behalf of the patient, for the diligence we show

    Sure. Dr. Hall has said it before and so have I. There do exist some chiros that I would actually feel fine referring my patients to. But that is despite their training and title… not because of it. A very important distinction.

  32. nwtk2007 says:

    nybgrus, when I have the experience of never having seen something, its reliable. I could do a study of what I’ve seen but I think it might be too supportive of what I have the experience of having seen, thus it might be too biased and a bit pointless. Yes, sarcasm.

    skeptical, every person who comes to me are here as result of trauma. Its a major red flag for x-ray. The department of health issued their recommendation for when to x-ray and MRI. The very first of their red flags to watch for was MVA. As the vast majority of patient seen in the ER for MVA are x-rayed as well, then I have no problem doing it myself as it IS the standard of care. I don’t x-ray all of my patients but if it is necessary then I’ll do it for many of the reasons I have cited previously.

    By the way, from where did you plagiarize your material? Also, thank you for grammar policing my use of miss-read. I have refrained from providing you the very same assistance for obvious reasons.

    nybgrus, your 19,000 hours of training in radiology is apparently wasted in a large number of cases. Anyone with that level of training should never, ever misread an x-ray. Amazing what I can do with 19,000 hours less training. That’s a bit shameful. Perhaps its the ego thing I had mentioned which might be interfering with a better record of x-ray misreads, thus exposing patients to further injury and, lets call it harm. Is it any wonder the number of folks hurt by medical mistakes is so high? Why yes, it is.

  33. The “plagiarized material” was a short portion of a blog post I wrote, titled “Chiropractic: An Indefensible Profession.” I copy and pasted it out of the book in which I was compiling my posts. I’m sure you’d love to read the entire article. In it I discuss most aspects of chiropractic, including its philosophical roots, the mythical subluxation, the fallacy of spinal manipulation, vertebral artery dissection and other dangers of this otherwise useless profession, the chiropractic concept of first subluxation, treating subluxations in newborns and the pediatric population, the completely false claims of being able to treat a number of conditions from colic to asthma, NUCCA therapy complete quackery, the complete lack of chiropractic ethics, the absence of informed consent, and a number of other false claims which clearly demonstrate that these sub-standard, poorly-performing students have absolutely no understanding of the human body (“we remove nervous system interference”), the quack promotion of maintenance care, the inability to judiciously utilize x-rays, the anti-vaccination stance (“You could seek to avoid the flu by injecting over 20 known poisons, but why? When you could prevent illness naturally!”), and after all of that (which is all 100% supported by studies, it’s all fact, fact, fact, not opinion), we review dozens of systematic reviews that shows chiropractic is wholly ineffective for every single condition, including the most recent systematic review which concluded:

    Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.

    * Posadzki P, Ernst E. “Spinal manipulation: an update of a systematic review of systematic reviews.” N Z Med J. 2011 Aug 12;124(1340):55-71.

    Again, thank you for admitting you needlessly and inappropriately x-ray patients. I know you’ll never stop, but I’m just glad that you at least admit that you x-ray patients when it’s not needed.

    BTW, from your post right above mine, where you openly state that you believe you can read x-rays better than a radiologist, who actually has training in reading x-rays, I’m sorry, but you’re an idiot. There’s just nothing else to say to you. You’ll never admit that your schooling is sub-standard, that your practice is quackery, and that you possess a hodge-podge of undeveloped skills and you cannot improve on them because you are surrounded by equally unskilled colleagues.

  34. nwtk2007 says:

    skeptical – “you openly state that you believe you can read x-rays better than a radiologist”

    skeptical – “thank you for admitting you needlessly and inappropriately x-ray patients”

    If you’ll misquote me and lie about that which you say I have said, then how could your blog post be anything but unreliable. But yes, it would be a fun read as I could probably agree with you on some points.

    You are not alone in your obsession to rid the world of chiropractic. Chirotalk is undoubtedly your favorite website. I’m almost tempted to ask if you have paid off your chiropractic school loans.

  35. nybgrus says:

    Anyone with that level of training should never, ever misread an x-ray.

    That is probably the singular most idiotic comment you have made. There is no such thing as absolutes. And part of the training we recieve in medicine is the knowledge to realize that. With that much training you can get very, very good – but never perfect as you seem to think you should.

    Of course, with just enough training you can think you are perfect. It is called the Dunning-Kruger effect. And that is precisely what one can do with 19,000 hours less training.

  36. Yup, Dunning-Kruger to a “T.”

  37. Harriet Hall says:

    @nwtk2007,
    “But it is a fact that the only miss-read x-rays I have EVER seen were miss-read by an MD”

    That’s your interpretation of your personal experience and has only anecdotal value. I could counter with anecdotes of chiropractors who not only mis-read x-rays but who took x-rays that were unreadable. Most notably, one took an x-ray and told a patient she had a fractured scapula. An MD asked to review the x-rays and was refused, but the patient was able to steal them and brought them to the MD. They were out of focus and could not be interpreted. Better quality x-rays showed no fracture.

    And there are still lots of chiropractors who point to x-rays and show patients the “subluxations” and NUCCA practitioners who draw bogus lines on them and claim to show a difference before and after adjusting C-1. And then there was the chiropractor who showed the patient someone else’s abnormal x-ray on purpose to fool him into accepting unnecessary treatment.

    Sure, these might be rare exceptions to the rule, but so might your experience. Without evidence from proper studies, how could we tell?

  38. @Dr. Hall, with respect to your comment about the chiropractor who showed the patient someone else’s abnormal x-ray: there’s an x-ray machine repair person in our city, who swears up and down and on his life, that he was repairing the x-ray machine in a chiropractor’s office, and the chiropractor told him “I don’t care if it takes pictures or not, just make sure it buzzes. I already have all the x-rays I need.” If one sentence could sum up chiropractic, that’s it.

  39. nwtk2007 says:

    Well I see, my having never seen a misread x-ray which wasn’t misread by an MD is anecdotal yet all of you guys “he said”, “she said” stories is not. Right.

    You could at least give us some case studies of this anecdotal evidence of chiro mistakes. Of course as I have only my memory of all misread x-rays being misread by MD’s to offer as there could be no studies to support my memory.

    Once again, you two-face your arguements.

  40. @nwtk2007,

    You could at least give us some case studies of this anecdotal evidence of chiro mistakes.

    I’m going to let you sit and think about that statement for a little bit.

  41. Harriet Hall says:

    @nwtk2007,

    “my having never seen a misread x-ray which wasn’t misread by an MD is anecdotal yet all of you guys “he said”, “she said” stories is not.”

    For crying out loud! I clearly identified my stories as anecdotal and said they were no more meaningful than your stories and that we couldn’t reach any conclusions without proper studies. The chip on your shoulder is making you imagine a double standard where it doesn’t exist.

  42. nwtk2007 says:

    Sorry Harriet, I was waking up when I read that one.

    skeptical – “I’m going to let you sit and think about that statement for a little bit.”

    In other words you don’t have any? I’m sure as often as this pops up in the medical community where patients have related the harm done to them by the chiro they saw first, that there would be such as would show up in the literature just based upon the simple fact of those, like yourself, who have this urge to rid the world of chiropractic.

    By the way skeptical, which chiro college DID you go to? I susspect you are just another incarnation of the same guy who shows up on the blogs under more and more different guizes. At first you seem to be a bit ignorant of chiropractic and then it turns out you have written a huge blog peice to condemn chiropractic and, as it turns out, are very familiar with their ilk, as you would probably put it. The biggest clue is the inability to delineate between the subluxation based chiro’s and the ones, such as myself, who are not part of that silliness.

  43. @nwtk2007, I find it amusing that you insult me by calling me a chiropractor. The sad thing is that each post you make, you look worse and worse. I don’t think any major journal publishes case reports of mis-diagnoses, especially by practitioners of alternative and other useless and ineffective “treatments.” In fact, I looked up what is typically published in a case study, and we see this:

    “Case reports should show one of the following:

    Unreported or unusual side effects or adverse interactions involving medications
    Unexpected or unusual presentations of a disease
    New associations or variations in disease processes
    Presentations, diagnoses and/or management of new and emerging diseases
    An unexpected association between diseases or symptoms
    An unexpected event in the course of observing or treating a patient
    Findings that shed new light on the possible pathogenesis of a disease or an adverse effect”

    I laughed at your request, because what is a case study if not an anecdote?

    By the way, here’s a link for you:

    http://s15.postimage.org/cq46pqirv/IMG_0453.jpg

  44. … you have to appreciate that you’re in a forum like this, and you have sub-standard education, sub-standard training, your practice is 99% quackery, and you’re telling better educated, smarter, more driven, and infinitely greater trained people that you’re smarter and better than them at what they do. Do you understand why you are met with skepticism, Rudy?

  45. Harriet Hall says:

    @nwtk2007,
    Case studies of chiropractic x-ray mistakes? Are you denying that NUCCA practitioners regularly read things into x-rays that aren’t there? Are you denying the whole history of chiropractic where chiropractors read x-rays as showing bones out of place and used them to diagnose “subluxations”?

    By the way, isn’t it curious that MDs readily admit that errors occur in reading x-rays and work to reduce them? For instance, see http://www.ncbi.nlm.nih.gov/pubmed/17411540 Can you cite anything comparable in the chiropractic literature, or is it the party line that chiropractors NEVER misread x-rays so they can’t possibly improve?

  46. jhawk says:

    @skepticalhealth

    “Indeed, multiple studies have found that chiropractors use X-rays unnecessarily. Studies have shown that up to 71% of patients being treated for low-back pain by chiropractors have been X-rayed by them.256″

    A study from 1977 that is 35 years old. Scratch 256 off of your list.

    “In 2002, a study assessed the views of chiropractors on the use of radiography (X-rays) for evaluating patients with acute low back pain. The study found that 63% of chiropractors stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week. 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low-back pain lasting less than 1 month. The study noted that the reasons given for use of radiography in this study are not supported by existing evidence. The study concluded that there appears to be a high rate of radiographic use by chiropractors which is consistent with findings in previous studies.262″

    N=26 with a 76% response rate which means total N=20. Is this generalizable? scratch 262 off your list.

    “In 2008, a study examined the instructions provided at chiropractic schools worldwide on the use of spine radiography (X-rays) compared with evidence-based guidelines for low-back pain. The study found that 56% of chiropractors believed, against evidence-based guidelines, that they should Xray the lower back in the absence of “red flags” for serious disease. The study concluded that this may be responsible for chiropractic over-utilization of radiography for low back pain.263″

    Interesting how you cherry picked the conclusion. It also said, This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. And from the results: Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that “routine radiography should be used prior to spinal manipulative therapy,” 29 (91%) disagreed that there “was a role for full spine radiography for assessing patients with low back pain,” and 29 (91%) disagreed that “oblique views should be part of a standard radiographic series for low back pain.” The only question that was not considered to be consistent with evidence based guidelines was this, “There is a role for the use of radiography in the evaluation of patients with acute low back pain, even in the absence of red flags for serious disease.” I think the authors should have added in the absence of trauma as well and could be a reason for the disagreement.

    “In 2011, a study aimed to determine how well chiropractors manage low-back pain in accordance with recommendations from an evidence-based acute low-back pain guideline. The recommendations were directed at minimizing the use of plain x-ray and encouraging the patient to stay active. The study found that 68% of chiropractors would take an X-ray even when it was not indicated, and 51% would give advice to stay active when it was indicated. The study showed a low adherence to recommendations from an evidence-based guideline for acute low-back pain.264″

    An Austrailian survey with a 37% response rate….. suffers from selection bias and is not generalizable. Also, the patient vignette’s don’t allow for the details and cues that would be found during history and exam. From the article: “Therefore, our conclusions are based on a measure of proxy behaviour rather than real behaviour. More research is needed to establish the extent to which proxy measures of behaviour can predict actual behaviour.” Scratch 264 off of your list.

    Is this what you call evidence? Did you actually read the full text of any of these studies?

  47. “I don’t like data that makes me look bad, so I’m just going to discard it! See, once I simply discount everything bad about my practice, it looks really good!”

    Really though, I appreciate your “review” of the data. I’m glad that you pride your profession for not taking full spine radiographs before treating for simple lower back pain (biggest eye roll possible.) By the way, look up what “selection bias” means, you completely got it wrong. Do they teach you *anything* in chiropractor school? I know for someone with a 2.5 GPA it must have been difficult to learn high-school level anatomy and physiology (“this is the heart!” “whoaahhh!!”) while learning to click a buzzer on the x-ray and look bewildered at all the white stuff that showed up (“that must be inflammation!!”), and learning to use a ruler to show that a vertebrae is subluxated, but… you had to learn something useful, right? Please?

    Here let me help.

    Selection bias:

    Selection bias is a statistical bias in which there is an error in choosing the individuals or groups to take part in a scientific study.

    In the study you referenced, they were randomly picked. Non-randomization would lead to selection bias. If anything, you meant “reporting bias.” Which is interesting, because with reporting bias, we’d see a tendency to under-report unexpected or undesirable experimental results, while we’d also see a tendency to accept expected or desirable results. And you know what? I’d agree that on most of these surveys they have a *reporting* bias, where these quacks get these surveys, and they know what answers they *should* give, and put that on the survey instead of writing what they likely do in real life.

    But here’s an interesting thing for you to wrap your brain around. These studies were published in the Journal of Manipulative and Physiological Therapy, which is a publication of the American Chiropractic Association (as far as I can tell; the JMPT is listed as a publication on the ACA website, and the ACA is listed in the society information for the JMPT.) The other study was published in … Chiropractic & Manual Therapies.

    So, do the journals that represent your professional organization publish crappy studies routinely? Could we then conclude that most studies published in your profession’s crappy journals are therefore crappy?

    Furthermore, are you saying that chiropractic is perfect and that every practitioner adheres to “evidence based” guidelines? (that kills me to type, because it’s such an oxymoron.) Do you refuse to admit that many chiropractors practice poorly? Need we forget, as Dr. Hall mentioned, about NUCCA practitioners who take repeated x-rays of the head while imagining they are moving the atlas and curing the body of all sorts of things? (I wonder where they learned this technique…)

    I certainly wouldn’t say that medicine is perfect, or that all medical doctors practice within evidence based guidelines.

    Just to refresh:

    Posadzki P, Ernst E. “Spinal manipulation: an update of a systematic review of systematic reviews.” N Z Med J. 2011 Aug 12;124(1340):55-71.

    Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.

    Aren’t you disgusted that people can do studies of the one thing your scummy profession offers, manipulations, and find that they are useless for every single condition? Doesn’t that make you feel horrible inside, and feel like a complete fraud for making your patients call you “Dr.”? You went to 4 years of school and took out an insane amount of loans to learn *nothing* useful. You take x-rays that aren’t needed and expose patients to unnecessary radiation, you can’t help people in any way, and you just take money from the sick. It’s just absolutely despicable.

  48. It is an interesting conundrum. If the journals that represent chiropractic, JMPT and CMT, regularly publish crappy studies about chiropractic, then how can the profession really have evidence-based guidelines? The evidence is crappy, so does that make the guidelines crappy too? Really sounds like you guys should just toss in the towel.

  49. jhawk says:

    @SH

    “By the way, look up what “selection bias” means, you completely got it wrong.”

    from the article:”The response rate was low (37%) and therefore the results have an increased potential for selection bias where those who choose to participate differ in important characteristics with those who do not choose to participate”

    “I know for someone with a 2.5 GPA it must have been difficult to learn high-school level anatomy and physiology” had to have a minimum of 3.0 to attend my school.

    “So, do the journals that represent your professional organization publish crappy studies routinely? Could we then conclude that most studies published in your profession’s crappy journals are therefore crappy?”

    nope. Some are crappy and some are not.

    “Furthermore, are you saying that chiropractic is perfect and that every practitioner adheres to “evidence based” guidelines? (that kills me to type, because it’s such an oxymoron.)”

    Where do you come up with this stuff. I have never said anything remotely similar to this.

    “Do you refuse to admit that many chiropractors practice poorly? nope.

    “I certainly wouldn’t say that medicine is perfect, or that all medical doctors practice within evidence based guidelines.’

    I would hope not and obviously I would not say that about chiropractor’s.

    “Posadzki P, Ernst E. “Spinal manipulation: an update of a systematic review of systematic reviews.” N Z Med J. 2011 Aug 12;124(1340):55-71. Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.”

    Let’s take a look at this study instead of taking ernst’s word for it. Many of his conclusions do not match with the actual results of the studies. He cites six studies on LBP (3 positive and 3 negative). The first negative states that SMT is not superior to other treatments so SMT is as good as any other treatment option. This cahnges the score to 4 positive and 2 negative. The second negative study is from Ernst and I can not get to the article and can not take his conclusion seriously due to previous bias in his articles (I am willing to change my mind if anyone has a link to this article but it will still just bring us back to 4 to 2). So, we have 4 positive and one negative. Look’s like SMT is effective for LBP.

    “Aren’t you disgusted that people can do studies of the one thing your scummy profession offers, manipulations, and find that they are useless for every single condition?” see above

    “Doesn’t that make you feel horrible inside, and feel like a complete fraud for making your patients call you “Dr.”?”

    Nope and I don’t make anyone call me doctor.

    “You went to 4 years of school and took out an insane amount of loans to learn *nothing* useful.”

    in your opinion.

    “You take x-rays that aren’t needed and expose patients to unnecessary radiation”

    I do not.

    “you can’t help people in any way”,

    I can help people with LBP. see above.

  50. I believe Ernst has over 600 publications. I’ll have to side with experience, instead of accepting the interpretation of a person with absolutely zero background in science and who fell sway to woo such as chiropractic. :)

    As I said many months ago, you wasted 4 years of “school” to learn a skill set that you could have picked up over a weekend by sitting in on a massage school. That’s just pathetic.

  51. dougdude10 says:

    @skepticalhealth – you are an asshole. what’s more is that you have a degree and are a Doctor. You put shame on your own profession by using comments like these:

    “By the way, here’s a link for you:

    http://s15.postimage.org/cq46pqirv/IMG_0453.jpg

    “@Dr. Hall, with respect to your comment about the chiropractor who showed the patient someone else’s abnormal x-ray: there’s an x-ray machine repair person in our city, who swears up and down and on his life, that he was repairing the x-ray machine in a chiropractor’s office, and the chiropractor told him “I don’t care if it takes pictures or not, just make sure it buzzes. I already have all the x-rays I need.” If one sentence could sum up chiropractic, that’s it.”

    “By the way, thank you for admitting you x-ray patients who are only diagnosed with a simple strain merely because you believe you are better at reading x-rays than real doctors. You’re a class act. I’m sure your patients appreciate you needlessly exposing their brain and body to radiation.

    Seriously, you quacks need to be delicensed.”

    “Wow. Man, did our country *screw up* when they got hoodwinked into allowing chiropractor quacks to be licensed.”

    “http://www.youtube.com/watch?v=9246yX1u0t8″

    Seriously, grow up, use your real English language and write something worthwire not condescending and degrading.

    Congrats on your M.D. certificate, too bad you are a peice of shit and probably aren’t married, have any friends, and can’t get any patients because of your bad attitude….Seriously, get a reality check. Chiros aren’t going away; so just do everyone a favor and cut the bullshit and your crap…..unless that’s all you are is talk and shit.

    last note – i’d rather die than come to a peice of shit doctor like you, hell i’d rather die from a chiropractic adjustment than have you and your bulling pompus attitude diagnose me and talk to me from a pedestal.

    get a life and grow up. stop posting b/c you have no life and are lonley b/c you’re an asshole…..a smart asshole but still an asshole

  52. dougdude10 says:

    here you go skeptic this is you btw

    http://mmaworldwide.com/c/a/i/Bullying_XL.jpg

  53. dougdude10 says:

    so if some chiro goes and kills himself it’s bc of skeptichealth

  54. jhawk says:

    @skepticalhealth

    “I believe Ernst has over 600 publications. I’ll have to side with experience, instead of accepting the interpretation of a person with absolutely zero background in science and who fell sway to woo such as chiropractic.”

    Resorting to the argument from authority I see. Here is a formal response to Ernst 2006 review of SMT that will match if not exceed your “authority”. http://chiromt.com/content/14/1/14

  55. dougdude, would the world notice or care? :) Heck, send your whole class to this thread.

    jhawk, from Ernst’s article:

    We have previously shown that the conclusions of SRs of SM for back pain appear to be influenced by authorship and methodological quality. Osteopaths or chiropractors tend to publish low methodological quality systematic reviews associated with positive conclusions (Table 3 and 4). Seven (38%) of the 18 SRs published either by chiropractors or osteopaths arrived at overtly positive conclusions8;9;23;36;39;40;49 and 11 (62%) arrived at negative or equivocal conclusions.7;10;21;25;27;30;31;37;38;42;46 Twenty four (88%) of the 27 SRs by independent research groups reached negative or equivocal conclusions.5-8;11-18;20-22;24-35;37;38;41-46 Only three (12%) arrived at positive conclusions.19;47;48.

    Your “positive” results are low-quality studies published by people who want/need them to be positive. Meanwhile, high quality studies done by people who don’t have a stake in SM being effective overwhelmingly find it ineffective. Ouch.

    Keep in mind these studies are investigating the “bread and butter” of your entire practice. The *one* thing you can claim to possibly have some efficacy on is several types of LBP, and it would seem that manipulation is wholly worthless for that too. Damn, sucks to be you. Your entire profession can be replaced with a $4 bottle of NSAIDs. – LOL – The sad thing is, if you were acting in your patients’ best interests, you’d close shop and just give them flyers with directions to the closest pharmacy or WalMart so they can get *much* cheaper and safer treatment for their LBP (you know, no risk of paralysis, stroke, death, or cancer from unnecessary ionizing radiation exposure from poorly educated lunatics.) But I guess you can’t feed your family without scamming sick people.

  56. *shock and awe* Chiropractors were upset that a massive review came out which said SM is ineffective?

  57. At best, you could say, “SM may or may not help with some types of LBP.” Is that really grounds for inventing a whole new “profession”, building a number of schools promoting this profession, giving them the (wholly unearned) title of “doctor” and allowing them to x-ray people? Nope.

    Chiropractic truly is a bunch of dummies that couldn’t get into any other professional school and just lead each other down stupider and stupider roads, with no actual idea of just how useless they really are.

  58. dougdude10 says:

    Seriously, grow up, use your real English language and write something worthwire not condescending and degrading.

    Congrats on your M.D. certificate, too bad you are a peice and probably aren’t married, have any friends, and can’t get any patients because of your bad attitude….Seriously, get a reality check. Chiros aren’t going away; so just do everyone a favor and cut the crap…..unless that’s all you are is talk.

    last note – i’d rather die than come to a peice of crap doctor like you, hell i’d rather die from a chiropractic adjustment than have you and your bulling pompus attitude diagnose me and talk to me from a pedestal.

    get a life and grow up. stop posting b/c you have no life and are lonley b/c you’re an jerk…..a smart jerk but still a condescending jerk

  59. dougdude10 says:

    you are a jerk and bully. what’s more is that you have a degree and are a Doctor. You put shame on your own profession by using comments like these:

    “By the way, here’s a link for you:

    http://s15.postimage.org/cq46pqirv/IMG_0453.jpg”

    “@Dr. Hall, with respect to your comment about the chiropractor who showed the patient someone else’s abnormal x-ray: there’s an x-ray machine repair person in our city, who swears up and down and on his life, that he was repairing the x-ray machine in a chiropractor’s office, and the chiropractor told him “I don’t care if it takes pictures or not, just make sure it buzzes. I already have all the x-rays I need.” If one sentence could sum up chiropractic, that’s it.”

    “By the way, thank you for admitting you x-ray patients who are only diagnosed with a simple strain merely because you believe you are better at reading x-rays than real doctors. You’re a class act. I’m sure your patients appreciate you needlessly exposing their brain and body to radiation.

    Seriously, you quacks need to be delicensed.”

    “Wow. Man, did our country *screw up* when they got hoodwinked into allowing chiropractor quacks to be licensed.”

    “http://www.youtube.com/watch?v=9246yX1u0t8″

  60. dougdude10 says:

    “As I said many months ago, you wasted 4 years of “school” to learn a skill set that you could have picked up over a weekend by sitting in on a massage school. That’s just pathetic.”

    what’s pathetic is you and your bully tactics

  61. jhawk says:

    @skepticalhealth

    “*shock and awe* Chiropractors were upset that a massive review came out which said SM is ineffective?”

    The response article is authored by MD PhD and Phd and DC. Exceeding your “authority”.

  62. jhawk says:

    @Skepticalhealth

    “We have previously shown that the conclusions of SRs of SM for back pain appear to be influenced by authorship and methodological quality. Osteopaths or chiropractors tend to publish low methodological quality systematic reviews associated with positive conclusions (Table 3 and 4). Seven (38%) of the 18 SRs published either by chiropractors or osteopaths arrived at overtly positive conclusions8;9;23;36;39;40;49 and 11 (62%) arrived at negative or equivocal conclusions.7;10;21;25;27;30;31;37;38;42;46 Twenty four (88%) of the 27 SRs by independent research groups reached negative or equivocal conclusions.5-8;11-18;20-22;24-35;37;38;41-46 Only three (12%) arrived at positive conclusions.19;47;48.”
    “Your “positive” results are low-quality studies published by people who want/need them to be positive. Meanwhile, high quality studies done by people who don’t have a stake in SM being effective overwhelmingly find it ineffective. Ouch.”

    The problem here which is discussed in the formal review is that many of these have multi-disciplinary aouthorship. Also, you could swing this the other way and say that the studies that had no author with expetise in SMT were biased.

  63. Harriet Hall says:

    @jhawk,

    The rebuttal letter you cite is a pathetic attempt at damage control. It accuses Ernst of not adhering to the standard systematic review methodology; he does adhere. It attacks him for only including reviews published after 2000; it is quite proper and customary to limit dates on such reviews. It whines about a few other things they didn’t like, and then ends with a distorted misinterpretation of what Ernst said about the risk/benefit ratio.

    It’s interesting to compare this criticism to the similar criticism of another Ernst systematic review on adverse effects of spinal manipulation. http://jrsm.rsmjournals.com/content/100/7/330.full Here’s how he answered his critics: http://jrsm.rsmjournals.com/content/100/10/447.full In both cases, the criticism is not productive or even credible and it amounts to the “mud battles” referred to in Ernst’s last sentence. The poor chiropractors haven’t a leg to stand on, and they are fighting back in the only way they know.

    The same kind of unreasonable criticism was offered by acupuncturists when Ernst wrote about acupuncture.

  64. nwtk2007 says:

    Harriet, I find your point with regards to chiro’s “fighting back” and mud battles to be somewhat silly in light of your collegue skepitical’s comments. It would apear that his main method of “fighting” is in throwing mud, but I do find it entertaining and enlightening. I also have my doubts as to his “credentials” but it’s irrelevant.

    There is no clear conslusion in any of the articles mentioned and the risks, as I have pointed out many times here are over stated, especially in light our previous discussions on the subject which can be reviewed at anytime and will not be repeated here again by myself.

    The continued focus on manipulation as being the “only” thing chiro’s do or offer (paraphrased) also reflects a lack of knowledge of what chiro’s do. Based upon many of the posts here and elsewhere, one might conclude manipulation is all chiro’s do. Well, I’m afraid not.

  65. :) The risk of something that is underreported is overstated? That makes sense.

  66. nwtk2007, regarding your adverse events, you can’t be foolish and deny that they are real and do occur. There’s entire books written on them (Kevin Sorbo’s book, etc) The problem is that each manipulation, especially of the cervical spine, is an new exposure to the risk of an adverse event happening. If the risk of adverse event is 1 in 100,000, and the patient receives 30 manipulations a year, well, you can do the math.

    As Ernst explains in the rebuttal that Dr. Hall linked:

    Several commentators criticize me for not discussing the frequency of serious adverse events and some even provide data of their own. They must have missed a whole section of my paper where I do discuss these issues. But let’s look at their figures: Bolton and Thiel state that there are over 2,000,000 cervical spine manipulations each year. Our UK survey disclosed 35 serious adverse effects within one year (JRSM 2001;94:107-110).2 Under-reporting was 100% in our series; this renders the calculation of any incidence impossible, so let’s be optimistic and assume it is only 90%. One severe adverse effect would thus occur in about 5,700 spinal manipulations. Assuming that, on average, patients receive about 30 spinal manipulations during the course of a treatment (three per session, 10 sessions per course), the figure would indicate that one in about 1,900 patients could experience a severe adverse effect. Of course, this is back of the envelope stuff, but it nevertheless might indicate that the true incidence of adverse events is quite different from what chiropractors believe.

  67. And re: mud-slinging, Dr. Ernst and Dr. Hall and referring to a published rebuttal to a published article. That is a far cry from a couple of goobers (us) in a comment thread on a (rather nice) blog. After all, you already gave me the worst possible insult, by calling me a chiropractor. :) (I must be chiro-phobic!)

    Ok, I’m back to work today.

  68. nwtk2007 says:

    @Harriet, I finally had the time to read the “rebuttal” letter to the Ernst work. You say that they “attack” him regarding the lack of materials prior to 2000. You also state that they “whine” about some “other things”, and you say he, Ernst, “does adhere”, as simple as that, to standard systemic review methodology.

    I just find your wording to be interesting, if not revealing.

  69. Harriet Hall says:

    @nwtk2007,

    “I just find your wording to be interesting, if not revealing.”

    Yes, it reveals my repeated frustration with unreasonable chiropractic apologetics.

    Please note that the rebuttal writers did not bother to specify how they thought Ernst had deviated from standard systemic review methodology. It was an unfounded accusation.

  70. nwtk2007 says:

    As regards to the authors response to the Ernst paper on adverse effects of manipulation, you state “the criticism is not productive or even credible and it amounts to the “mud battles” referred to in Ernst’s last sentence. The poor chiropractors haven’t a leg to stand on, and they are fighting back in the only way they know. ” “Poor” chiropractors. OK.

    I really saw nothing in their response which appeared to be “mudd” slinging but rather, simple “criticisms” of Ernst’s paper. I think perhaps it is he who doesn’t understand the difference between being negative and criticism.

    I would actually like to review each of these cases myself. The ones I have reviewed are truly not clear as to cause. It would seem that in some cases the mere mention of having seen a chiropractor was taken to mean manipulation was performed and thus, all other possible factors beyond that point ignored or not investigated.

    I would imagine we could make the same case for other possible and likely causes in most of the case studies if other factors were actually considered. Why not present the actual case studies themselves for all to examine rather than rely on the authors view. A different picture might yet emerge.

  71. jhawk says:

    @HH

    “The rebuttal letter you cite is a pathetic attempt at damage control. It accuses Ernst of not adhering to the standard systematic review methodology; he does adhere. It attacks him for only including reviews published after 2000; it is quite proper and customary to limit dates on such reviews. It whines about a few other things they didn’t like, and then ends with a distorted misinterpretation of what Ernst said about the risk/benefit ratio.”

    I disagree.

    “In both cases, the criticism is not productive or even credible and it amounts to the “mud battles” referred to in Ernst’s last sentence.”

    You are joking right. Critiquing articles is part of science and there is absolutely no mud slinging in this response.

    “The poor chiropractors haven’t a leg to stand on, and they are fighting back in the only way they know.”

    Once again this article is authored by MD Phd, many PhD’s and some DC. It is not poor chiro’s fighting back as you state. The main criticism in my view which is brought up in the response is that if SMT is not superior to other treatments it gets a blanket negative study and this is disengenuous at best. If you read the results of this study you will plainly see they do not match the conclusion.

  72. Harriet Hall says:

    @nwtk2007,
    “I would actually like to review each of these cases myself….Why not present the actual case studies themselves for all to examine”

    This was a systematic review; no journal would simply reprint a bunch of case studies. Feel free to do your own review and publish it. Ernst’s review lists the case reports with links to abstracts, so they are not hard to find. Or you could do your own independent search.

    “The ones I have reviewed are truly not clear as to cause.” There are plenty of “smoking gun” cases where the patient developed symptoms immediately after manipulation. If you reject these as causal, perhaps you can explain to us what kind of evidence it would take to convince you. By the way, much of the chiropractic literature accepts that there is a risk of stroke with neck manipulation, and they discuss informed consent and methods of pre-manipulation screening that might reduce the risk.

  73. Harriet Hall says:

    @jhawk,

    “I disagree.”

    That’s not helpful. You might offer some specifics.

    “Critiquing articles is part of science.”

    Sure, rational constructive criticism is productive. The kind of criticism directed at Ernst is not. For example, they said he didn’t follow standard systematic review methodology but they didn’t explain how they thought he had deviated. And they criticized him for choosing a cut-off date, which is standard methodology. They wished he had included earlier studies simply because some earlier studies favored their beliefs. It would be convenient if you could start with a conclusion and choose the time set that best supported it, but that’s not good science.

    “If you read the results of this study you will plainly see they do not match the conclusion”

    I think you have misunderstood Ernst’s conclusion, that if SMT is ineffective for most conditions, not superior to other treatment methods for low back pain, and carries a real risk, a common-sense evaluation of the risk/benefit ratio discourages using it.

  74. On phone sorry

    Lots of missing thr big picture here. Our two Chiros are poorly tryin to dissect every word dr hall writes, but they seem to be missing the fact that the evidence shows spinal manipulation useless fr every condition. Sure newt can debate the LBP one if he just ignores the negative reviews and o ly accepts the positive reviews, but, let’s be honest, If there is so much doubt concerning spinal manipulation in this regard – so muh doubt that multiple systematic reviews and systematic reviews OF systematic reviews can find it to be ineffective, thn how can u place so much faith in it? How can you think hires ping good when TE science tells us you liket arent doing anything?

    Again, with so little science supporting manipulation, how can you continue to practice it?

    Sorry too much autocorrect

  75. jhawk says:

    @HH

    “Sure, rational constructive criticism is productive.”

    Yes, exactly what this reponse is.

    “The kind of criticism directed at Ernst is not. For example, they said he didn’t follow standard systematic review methodology but they didn’t explain how they thought he had deviated. And they criticized him for choosing a cut-off date, which is standard methodology. They wished he had included earlier studies simply because some earlier studies favored their beliefs. It would be convenient if you could start with a conclusion and choose the time set that best supported it, but that’s not good science.”

    Uhhh from the article: “Based on the inclusion and exclusion criteria, the review excluded at least three eligible reviews [3-5] and included at least one review that we do not consider systematic [6]. The review did not reference the eight excluded studies to enable readers to verify the judgments made.
    Second, the authors elected to assess the quality of included reviews quite loosely even though more robust and clinimetrically sound approaches are available and have been widely used by others [7]. The authors only made casual comments about certain reviews being more important than others. Such an approach is prone to bias and unnecessary subjectivity [8].
    Third, the authors did not report on any pre-specified rules to evaluate the evidence in aggregate and did not perform any sensitivity analysis to test the robustness of their conclusions. Inference about the overall evidence supporting or refuting spinal manipulation was solely based on extraction of text from the conclusions of the individual reviews. The methodological quality and validity of the included reviews apparently were not assessed. There was at least one example of the extracted information from one of their own review abstracts which was in conflict with their reported results [9].
    Fourth, there was no attempt made to analyze the nature of discordance between the selected reviews’ conclusions for each clinical condition. In our view, this should have included consideration of the study question, methodology and quality of the reviews, as well as the number of randomized trials included in each review. The authors claim that they authored or coauthored 3 of the 16 included reviews and that these all were unbiased and of high quality. From their own table and reference list it is evident that 5 of the 16 reviews (all negative conclusions) were authored or coauthored by Ernst [9-13]. As to the methodological quality of these reviews, we leave it to the scientific community to judge.”

    “I think you have misunderstood Ernst’s conclusion, that if SMT is ineffective for most conditions, not superior to other treatment methods for low back pain, and carries a real risk, a common-sense evaluation of the risk/benefit ratio discourages using it.”

    Please enlighten me on the major risk of SMT for LBP.

  76. It’s so exhausting reading these pathetic arguments from the chiropractors. Everything is so circular, you just keep going around and around, and every time you’re stuck on one thing, you move to another and ignore the other stuff.

    Summary of thread:
    - No evidence that chiropractic spinal manipulation is effective for any medical condition.
    - There is a small possibility that chiropractic spinal manipulation may or may not be somewhat effective for specific types of lower back pain, however equal and superior treatment modalities are cheaper and safer.
    - Chiropractors regularly practice outside of “evidence based guidelines” and take unnecessary x-rays.
    - Chiropractors do not have any unique *effective* treatment to offer any patient.
    - Chiropractic college is uncompetitive, and maintains low standards for applicants (low GPA, no admissions test, no necessary college degree.)
    - Chiropractic colleges openly advertise teaching their students quackery such as applied kinesiology, BEST, network spinal analysis, NUCCA, and also advertise that you can use chiropractic manipulation to rid the body of infectious disease such as ear infections.
    - Chiropractors have limited schooling, and are spread too thin to achieve any depth-of-knowledge in any particular field, and are therefore handicapped.
    - Chiropractors have less than half of the training of legitimate medical practitioners.
    - Chiropractic manipulation runs the risk of paralysis, stroke, phrenic nerve damage, death, and a number of other conditions.
    - Because chiropractors do not receive adequate training, are sub-standard students, and do not offer any legitimate treatment modalities to potential patients, they should not be practicing under any circumstances.
    - Because chiropractors are unable to treat any medical condition that is diagnosed by x-ray, and because their care is not superior to physical therapists who do not have to routinely x-ray their patients, chiropractors should never x-ray any patient under any circumstance. Furthermore, because chiropractors have limited training in both taking and reading x-rays, by performing either of these tasks the chiropractor is a threat and a danger to their patient.
    - Because of the risks inherent in chiropractic manipulation, and the fact that manipulation is ineffective for virtually every possible condition, manipulation should not be used on any person for any reason.
    - Because of these reasons, any patient that pursues chiropractic care will receive sub-standard care.

    Despicable!

  77. Harriet Hall says:

    @jhawk,

    The rebuttal letter is not rational constructive criticism.

    From Ernst’s study:
    “Reviews were defined as systematic if they included an explicit and repeatable method for searching the scientific literature and if there were explicit and repeatable inclusion and exclusion criteria for studies. These criteria are the first two items from a scoring system previously used to assess the methodological quality of reviews of spinal manipulation.
    To be included, systematic reviews had to be concerned specifically with the effectiveness of SM and to include evidence from at least two controlled clinical trials. Systematic reviews were considered regardless of the medical condition they referred to. Systematic reviews of complex packages of interventions which happened to include SM were excluded.”

    The rebuttal letter cites 3 eligible studies that they think should have been included. Two of those clearly should not, since they were not “concerned specifically with the effectiveness of SM.” One was a systematic review concerned with all sorts of noninvasive physical treatments for headache. The other was concerned with everything from hypnosis to acupuncture. I don’t have access to the full text of the third excluded study, but the abstract does not describe “explicit and repeatable inclusion and exclusion criteria for studies.” And even if it had been included, its results would only have tended to reinforce Ernst’s findings.
    I’m not going to waste any more time or energy deconstructing every detail of the rebuttal. I think I have adequately shown that it is not well-reasoned or acceptable criticism.

  78. Harriet Hall says:

    @jhawk,

    “Please enlighten me on the major risk of SMT for LBP.”

    Since you apparently didn’t read the article, I’ll copy one pertinent section for you:

    “The injuries occurred in the cervical (33%), thoracic (22%) and lumbar spine (44%). In nine cases, they were associated with spinal cord injuries (myelopathy, quadriparesis, central cord syndrome or paraparesis); two patients experienced cauda equina syndrome; six patients developed radiculopathy; and three patients had pathological fractures related to cancer which the chiropractors had failed to diagnose.”

  79. nwtk2007 says:

    Existent in the very nature of these “injuries” and what, apparently a physician, is saying in each case, injury as a result of manipulation, lies in the question of why did the patient go to the chiropractor in the first place. Second, with so many like skepticalhealth out there, making these claims, then I could not accept them as evidence unless I reviewed each one separately.

    Injuries such as are cited are not caused by manipulation. In fact, I seriously doubt if I could cause those conditions if I wanted to. I can see the risk of cervical manipulation if performed with full rotation and as faar as I know, most chiro’s have dropped that form of manipulation.

    I can also appreciate the mention of pathological fractures. A very good reason to perform x-rays. Unfortunately for many of those who have come to me for care, we found that there indeed was a pathology which was coincidental to their injury or aggravated by it. In fact, you make a very good argument for MRI prior to the treatment of cervical/thoracic/lumbar sprain secondary to trauma. Expensive but then again, with imaging centers offering cash rates, possibly affordable. And skeptical will appreciate the lack of radiation exposure of an MRI. Of course some of these conditions are clinically diagnosed.

    I would reiterate that these conditions can be caused by trauma and would have symptomatically which might induce one to go to a backa dn neck doctor like a chiropractor.

  80. nwtk2007 says:

    I love how comments get stuck in moderation sometimes. I guess its my profane nature.

  81. Harriet Hall says:

    @nwtk2007,

    “Injuries such as are cited are not caused by manipulation… these conditions can be caused by trauma”

    In these cases the trauma was the manipulation. Chiropractic insurance companies have paid out claims for such injuries. The study is here: http://www.ncbi.nlm.nih.gov/pubmed/16291108?dopt=Abstract It reviews patients in a neurosurgical practice. Neurological conditions were compared pre-manipulation, post-manipulation, and post-surgery. Their symptoms worsened after spinal manipulation. There is no way this could be explained away as due to prior trauma. You are grasping at straws and making excuses rather than facing reality.

  82. nwtk2007 says:

    As I cannot find a place to read this then I will have to leave it in the hear-say ben for now. The abstract and brief review doesn’t make it clear if the conditions were caused by the manipulation or simply made it worse, which could be understandable. The article clearly suggested it might be a good idea to do scans to screen for such conditions which suggests that we are hearing about conditions in place prior to manipulation and made worse by the manipulation. I have done scans for just such reason.

    Interestingly, insurance companies will balk at the medical necessity of such scans if done to screen for conditions which might be made worse by manipulation and yet, if scanning is not done, accuse the doctor of irresponsibility in not doing the scan; the later being in a court where they, the insurance sompany, are doing all they can to NOT have to pay for the patients treatment as they were contracted to do.

    But as I have said, I’d need to read the paper to clearly see what is being said; that the manipulation caused the conditions or made them worse. We’ll see.

  83. I’m sorry, did you just refer to yourself as a doctor? BWAHAHAWHAWHAHAHAHAHA!!!

    You’ll have to forgive us if we aren’t interested in your interpretation of a scientific paper or a case study. Let’s be honest, science isn’t your thing. If you were even slightly inclined, chiropractic school wouldn’t have been on your radar. I do appreciate that instead of defending yourself against the systematic review of systematic reviews which concluded manipulation is not useful for any medical condition, you’re now trying to prove “well, at least we aren’t killing people.” Sadly, you are.

    You should read this site:

    http://whatstheharm.net/chiropractic.html

    Especially the patient “Sandra Nette.” Her story brought me to tears. Just Google her name, its one of the saddest stories ever. And this was caused by a chiropractor doing something to her neck that has never, in the history of man, been proven to be effective for anything. It’s funny you just called yourself a “neck doctor”, because you have zero reason to ever touch a patient’s neck. If you ever manipulate a patient’s neck, then you are directly contributing to their morbidity for no reason whatsoever. If you manipulate a neck, then you are pure scum, because you are knowingly trying to injure this person without any reason to put this patient at such a risk. The bad things that I would wish upon you chivalry forbids me from saying.

    I just can’t be polite to you. You’re just a *fool* if you think that chiropractic manipulation is incapable of hurting people. There’s one truth in all of medicine: anything that can help you can hurt you.

  84. I just hope you realize the two completely contradictory things you have going on. On one hand you pretend to play scientist and read studies and act like you can interpret thing and spot flaws (Does it support me? Good study! Does it show my practice is a fraud? Bad study!), but on the other hand you do completely unscientific things, like …. brag about being a “neck doctor.” In my eyes, you’ve openly admitted that you are a sociopath. I wish there was a way I could verbalize the disgust and contempt I have for people like you.

  85. nwtk2007 says:

    skeptical – “Especially the patient “Sandra Nette.” Her story brought me to tears.”

    Not likely.

  86. Looks like you’re out of material, socioquack. See you in the next thread re: chiropractic.

  87. nwtk2007 says:

    Far from it. Just a bit busy.

    I must say just how unimpressed I am with you. Indeed, every post you make reveals the level of insanity which has brought you to this point in your life.

    Incidentally, you never mentioned the blog where you are posting all of your antichiro materials. And way back in this thread, you referred to me a Rudy? Or did I miss something?

  88. nwtk2007 says:

    skeptical, I posted this question regarding Ms Nette’s condition back in 2008,

    ### “As to the person you heard from who had a vertebral artery torn, how do you know and how do you know it was due to manipulation? What is their medical history and why did the go to a chiro in the first place? Are they a smoker? Are they old, female, male? Do they have hypertension, diabetes? Is there a reasonable chance that the chiro could have foreseen it coming in the patients exam findings, medical history? Did the chiro perform an adequate exam or history? Have you seen the patient’s PCP records? Has the patient ever made the same complaints to the PCP prior to going to the chiro? Did you even think about any of this before you thru up this onfo onto the blog? Does anybody? Do we ever hear the whole story and get to see the facts of the case other than “hearing from someone who had their vertebral artery damaged by a chiro manipulation”?

    Is this an anecdotal story with the very same merrit you give other anecdotal stories on your blog here? Is there more here than just correlation giving rise to causation?

    Is the chiro being investigated? Are they going to try to have the chiro desicplined? Are they going to report the chiro to the licensing authority of the chiro? Are they going to sue the chiro for malpractice? ###

    It was never answered. Perhaps you could now once you get the tears out of your eyes.

    In that same thread, there was a doctor who related an anecdotal story of a patient who claimed to have “had a tear” in their vertebral artery after a manipulation by a chiro. I asked the following unanswered question –

    ###”So this person felt a tear? Do you think there are receptors in the vertebral artery that would yield that sensation? How long of a tear do you think would be needed to get that sensation of feeling a tear? How long of a tear to bring on the real S/S of a vertebral artery tear/stroke? If the “tear” were that big as to be felt as a “tear”, do you think the person would be in a position to relate it to you verbally?

    Do you just take the patients word for it that there was a tear in the vertebral artery? Is there any supporting imaging?

    I am not denying it. I am just not believing every story and accusation that the chiro caused the stroke. It IS a case of causation vs correlation. ####

    The point here being that there in inadequate information to conclude that manipulation actually caused a tear/stroke/etc. As in the doctors anecdotal account of a patient who “said” they felt a tear and the doctor concluding it was caused by manipulation. Oh, I don’t deny the smoking gun, but anyone’s statement of “overwhelming” evidence I don’t. In much the same way, the above cited paper needs clarification.

  89. jhawk says:

    @HH

    “The rebuttal letter is not rational constructive criticism”

    Well, whether we agree or disagree about the rebuttal letter is a moot point becasue it does not change the fact that Ernst blanketly rated SMT studies as negative in both of his reviews of reviews because they were not superior to other treatments. This is bad science.

    Then, in the other article you posted (adverse effects of SMT), Ernst says the following: “The effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.”

    He cites only one study. Which study is this? His review of reviews which shows through bad science that SMT is not effective.

    I will have to get back to you after I have time to read the neurosurgical practice article.

  90. Harriet Hall says:

    @nwtk2007,

    These are not just unreliable patient stories. There are plenty of cases where vertebral artery tears were documented by imaging studies.

    Your questions about whether the chiro could have foreseen it or did an adequate exam and history are revealing. Instead of blaming the manipulation, now you are trying to blame the manipulator in an attempt to reassure yourself that it couldn’t happen to you because you are more careful. Unfortunately, there is no reliable way to predict these adverse events from history/physical, or even with tests.

    I would like you to seriously consider whether any case could ever qualify in your mind as good evidence that manipulation had caused a stroke. An asymptomatic patient or a patient with symptoms only in a remote part of the body gets a neck manipulation and has a stroke on the chiropractor’s table. You could always argue that she would have had a stroke anyway and that the manipulation was not causal, that the same thing might have happened during a shampoo at the beauty parlor, or that her genetic profile or the bacon and eggs she had for breakfast that morning were the real cause, or that it was an act of God. Anything can be rationalized/explained away if you try hard enough.

    Do you know of a single case where you would agree that manipulation caused a stroke? Before you say another word on this subject, please tell us what evidence you would find acceptable.

  91. Harriet Hall says:

    @jhawk,

    Ernst did NOT “blanketly rate SMT studies as negative.” His review of systematic reviews did NOT “show that SMT is not effective.”

    He showed that SMT is as effective as other treatments for low back pain. He then offered the opinion that “the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise.”

    You have a right to disagree with his opinion, but you don’t have the right to mis-read and mis-represent the facts.

  92. nwtk2007 says:

    Harriet, I have stated what I would like to know in order to really be able to make a reliable judgement about manipulation as cause.

    ###“As to the person you heard from who had a vertebral artery torn, how do you know and how do you know it was due to manipulation? What is their medical history and why did they go to a chiro in the first place? Are they a smoker? Are they old, female, male? Do they have hypertension, diabetes? Is there a reasonable chance that the chiro could have foreseen it coming in the patients exam findings, medical history? Did the chiro perform an adequate exam or history? Have you seen the patient’s PCP records? Has the patient ever made the same complaints to the PCP prior to going to the chiro?”###

    None of this is presented other than “the patient had a stroke or vAD soon after having manipulation”.

    The same would be true in the cases where the patient had a stroke after seeing the PCP. (Referring to the study showing that strokes happen equally after seeing a chiro or PCP – not withstanding the younger of those studied which had a three fold inc in the likely hood of seeing a chiro prior to their stroke or VAD. Which, interestingly, it would seem that the older group would be most likely to have a VAD after seen a chiro than the younger group.)

    Basically, more history and analysis is needed before it is concluded that the patient wasn’t having an ongoing episode rather than being caused by manipulation or was there that the doctor, chiro or PCP, could be alert to finding in order to suspect a stroke prior to any form of treatment.

    Like I have said, there are too many like skeptical out there who would find out a stroke victim had seen a chiro at any time in their life and thus, conclude it was seeing the chiro. The way skeptical misquotes, he could not provide reliable information regarding a case, nor could someone else with such insane drive against chiropractic.

    There is a case where the victim exhibited a stroke in progress immediately after a manipulation. You presented it before and it is pretty hard to argue with that sort of information.

    But patients go to the chiro for s/s which preclude the event or its full expression and if the stroke occurs sometime later, it becomes problematic as to whether the stroke was, indeed, caused by the manipulation. Without more information, it cannot be s/s/manipulation=stroke/ VAD. What about the older half in the study I mentioned who went to the chiro and not the PCP? Their age would make them even more susceptible to VAD would it not? Yet the incidence rate is equal to those who went to the PCP.

  93. Harriet Hall says:

    @nwtk2007,

    I can’t believe you are still referencing the flawed Cassidy study. Mark Crislip demolished that study at http://www.sciencebasedmedicine.org/index.php/chiropractic-and-stroke-evaluation-of-one-paper/ That study did not even ask whether the patients studied had had their necks manipulated.

    What are you saying? If a patient smoked, was old, had hypertension, diabetes, etc. then does that mean that manipulation couldn’t have been the cause of stroke? Or does it mean that manipulation should not have been used and the chiropractor was incompetent? If a patient has a stroke on the table, does that mean he must have already been in the midst of an ongoing stroke?

    Does “pretty hard to argue with” mean you do accept that manipulation sometimes causes strokes?
    Do you really think there is some way to avoid this by screening patients?
    What conditions do you think neck manipulation is effective for? Do you reject the published evidence showing that it is not superior to gentle mobilization and other treatments and is ineffective when used alone? Do you use it? What are your criteria?
    What do you think of upper cervical adjustments for non-neck problems?
    What do you think of NUCCA?

  94. nwtk2007 says:

    @Harriet

    It’s flawed (the Cassidy Study) but has some interesting points. I believe we were to assume the chiropractic patients were manipulated and assuming they were, it still begs some questions. If they weren’t manipulated then it becomes a bit lame in that the 3x inc likelihood of seeing a chiro in the younger aged group becomes meaningless. I simply mention it in terms of why a better history and more in depth information is needed for a determination of cause or even a suggestion of cause of stroke/VAD.

    As to conditions such as diabetes, high BP, smoking, etc yes, they could be red flags/contributory factors and, at the very least, indicators of the need for greater caution in the choice of treatment modalities. I see a lot of medical records and can assure you that both sides of the fence need to do more thorough examinations with just such possibilities in mind, especially after trauma such as MVA. I’ve observed my daughters being examined many times and know of only one instance of a cranial nerve eval being performed and that by a neurosurgeon. The way I see it, if folks think a manipulation could cause a stroke/VAD then most certainly, an MVA could although I haven’t seen anything suggesting an inc in stroke/VAD in MVA’s.

    Do I think strokes/VAD’s at the hands of a manipulator could be avoided by some screening process. To an extent, it could decrease the chances of one occurring. Even if one doesn’t think manipulation can cause a stroke/VAD, it is still something one can do.

    As to what I use manipulation for, that would be any spinal sprain/strain; pretty much most of what I see. Very effective on post trauma related HA’s. I don’t do manipulations of extremities.

    Is the manipulation I do better or more effective than gentle mobilization? I don’t know, much of what most of the chiro’s I know is gentle mobilization. The image of chiro’s doing manipulation is that of one really cranking on a neck or back. That’s as accurate as folks thinking all Texans wear cowboy hats and carry a six shooter, the later becoming increasingly popular. So, I do use it as well as a few other modalities, both passive and active. Quite a bit of active, therapeutic stretching and exercises. My criteria would be joint restrictions or decreased ROM, muscle spasm and palpable tenderness, the absence of a true radiculopathy, basically the absence of any contraindications, perceived patient tolerance to mobilization, and a patient’s willingness to be manipulated. Some will become resistant with even doing some passive ROM testing.

    I really couldn’t address NUCCA. I’ve been doing this since 1994 and haven’t strayed into many of the techniques outside the basic manipulation and ancillary therapies.

  95. Harriet Hall says:

    @nwtk2007,

    I certainly agree with you that stroke should not be attributed to manipulation without good reason, and that case reports should include detailed information. I think existing published reports usually contain enough information to reasonably implicate manipulation.

    “very effective on post trauma related HA’s”

    Really? What’s your evidence? Citations, please.

    “I really couldn’t address NUCCA.”

    That statement is very revealing. Sam Homola has not “strayed into that technique” yet he had no trouble addressing it at http://www.sciencebasedmedicine.org/index.php/the-problem-with-chiropractic-nucca/

    It seems you don’t know/care enough about it to realize it is nonsense and to discourage it for your colleagues and patients.

  96. jt says:

    “The chief deficiency I see in the skeptical movement is its polarization: Us vs. Them — the sense that we have a monopoly on the truth; that those other people who believe in all these stupid doctrines are morons; that if you’re sensible, you’ll listen to us; and if not, to hell with you. This is nonconstructive. It does not get our message across. It condemns us to permanent minority status.”
    ― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark

  97. @nwtk2007, everything you write is based off of your “experience,” but your experience is from being educated at a garbage chiropractor school (Parker) that actively promotes quackery on its website and then practicing among quacks of a similar ilk. A bunch of bad singers don’t join up to make a great choir. Similarly, a bunch of quacks don’t come together and do good medicine. They just do bad medicine in great quantities.

    Have you ever told a patient that there is a risk they could die, have a stroke, or become paralyzed before you manipulate them?

    @jt, quoting Sagan to defend chiropractic is sacrilegious.

  98. nybgrus says:

    I love Sagan. The man was truly a legend and the world is a better place for him having lived here.

    I agree with most things he said. I do not agree with everything, that particular quote included. It isn’t wholly and utterly incorrect – there is a useful lesson to be learned from it. But I do not feel that it adequately addresses the current situation vis-a-vis skepticism, anti-science, pseudo-science, and denialism.

    Plus, it is often dropped exactly like that – as if Sagan were the god of the skeptic religion and we are violating a sacresanct rule. Quoting someone intelligent and worthy is only useful if included in a reasoned argument – not when it is the stand-alone argument.

  99. jhawk says:

    @HH

    “Ernst did NOT “blanketly rate SMT studies as negative.”

    Studies that showed SMT were as effective as other treatments were rated negative. It is in the results.

    “His review of systematic reviews did NOT “show that SMT is not effective.”He showed that SMT is as effective as other treatments for low back pain. He then offered the opinion that “the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise.”

    Then why does his abstract conclusion (which is the only part many people read) say this and only this: “Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.” This is disingenuous at best.

  100. Harriet Hall says:

    @jhawk,

    “Studies that showed SMT were as effective as other treatments were rated negative. It is in the results.”

    What!!?? Are we talking about the same study?
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420782/?tool=pubmed

    The results section reads: “The meta-analysis by Assendelft et al.9 suggested that SM was superior to sham therapy or to ineffective/harmful interventions for low back pain. The meta-analysis by Gross et al.12 implied that combining SM with other treatments, particularly exercise, is effective in reducing neck pain but demonstrated that SM is not effective as a singular treatment. Bronfort10 concluded that SM and/or mobilization are viable options for treating low back and neck pain. Bronfort13 concluded that SM has a better effect than massage and a comparable effect to prophylactic drugs for headache. Reid21 found only limited evidence from methodologically poor trials for effectiveness in cervicogenic dizziness. All other conclusions agreed that the effectiveness of SM is not supported by the results from rigorous clinical trials.”

    See table 1 for details of overall results of all 16 reviews. I fail to see how anyone coud interpret this as “studies showing SMT was as effective as other treatments” or that “studies showing effectiveness were rated negative.”

    The statement in the abstract conclusion accurately represents these findings.

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