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231 thoughts on “Should I Take a Multivitamin?

  1. weing says:

    Well, I don’t think it’s worth cleaning out my basement to find the original article.

  2. Joe says:

    weing wrote on 17 Jul 2008 at 11:22 pm “Well, I don’t think it’s worth cleaning out my basement to find the original article.”

    You are right, when dealing with a chiro- the chiro imagination trumps facts.

    nwtk2007 wrote on 17 Jul 2008 at 10:28 pm “I saw that one. It is sited [sic] by others as incorrect”

    You see, weing, nitwit2007 doesn’t even have to cite sources, you are simply incorrect.

  3. daedalus2u says:

    nwtk2007 huh? didn’t you read the study linked to above (which is available for free download), where they measured how increases in vitamin C intake caused increases in oxalate and in a “stone forming” population there was an increase in calcium oxalate saturation from below where stones could form to where they could form?

    http://jn.nutrition.org/cgi/content/full/135/7/1673

    If we do a search on Google Scholar, we find that the article has been cited 18 times.

    http://scholar.google.com/scholar?hl=en&lr=&cites=5759871201307082276

    One of the citing articles, this case report, directly attributed kidney failure to excess vitamin C, which resolved when the excess was eliminated.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2235877

    So which of these citing articles dismiss the finding? All the ones I read didn’t dismiss it and said it might be important in some individuals.

  4. nwtk2007 says:

    There are studies showing inc vitC results in inc oxalate formation, there are just none that show inc oxalate cause inc in stones.

    Once again, in the words of this forum, correlation does not mean causation.

    I only have a few minutes here so here is a quick one from a peer reviewed medical journal,

    Simon, Joel A. and Hudes, Esther S. Relation of serum ascorbic acid to serum vitamin B12, serum ferritin, and kidney stones in US adults. Archives of Internal Medicine, Vol. 159, March 22, 1999, pp. 619-24

    In fact, there is some evidence that vit C acidifies the urine which aids in dissolving most stones.

  5. nwtk2007 says:

    Heres a couple more:

    Intake of vitamins B6 and C and the risk of kidney stones in women
    Curhan, G. C., Willett, W. C., Speizer, F. E., Stampfer, M. J.
    J Am Soc Nephrol 10:4:840-845, Apr 1999

    J Urol. 1996 Jun;155(6):1847-51.

  6. pook says:

    nwtk,
    You tell them, sister! Btw, how good is chiropractic treatment of kidney stones? Which subloxation is most commonly involved?

  7. nwtk2007 says:

    Pook, that would be the P1 subloxation. When innate is blocked at that level the result is stones, as opposed to getting stoned, which is required to find the illusive P1 subloxation.

  8. daedalus2u says:

    nwtk2007, you said

    “I saw that one. It is sited by others as incorrect in the assumption that elevated levels of oxalate means increased stones.”

    Now it turns out that you didn’t actually see any articles that cited it, you just found some articles from many years earlier that didn’t report a correlation. They did find a odds ratio of 1.06 (95% CI 0.69 to 1.64) in women, which is completely consistent with a subgroup being susceptible to oxalate kidney stones from excess vitamin C.

    The Archives of Internal Medicine article specifically excluded from analysis individuals with the highest vitamin C blood levels. Those individuals with levels in the highest 0.5% were excluded from analysis. Presumably those were the individuals taking the highest levels of vitamin C supplements.

    This more recent large study did find a strong correlation in men, 1.41 (95% CI 1.11 to 1.8).

    http://jasn.asnjournals.org/cgi/content/full/15/12/3225

  9. nwtk2007 says:

    Quite the cantrare dadelus, your first reference has been sited many times. Just for a quick look, look at the orthomolecular medicine site. Your other reference is a case study (essentially anecdotal) regarding nephritis and kidney failure.

    You are still equating increased oxalate levels with kidney stone formation which is just not documented and has been pointed out as being a misunderstood myth.

    Your article is sited along with others for just that point.

  10. Fifi says:

    What the hell is a “cantrare”? Did you mean to say “Au contraire”, as in the French expression that’s commonly used in English? Nwtk, for someone who berated people here as being pseudo intellectuals, you’re doing a hell of a lot of rather pretentious (and incorrect) siting [sic] and “cantraring” [sic]. It doesn’t get much more pretentious than misusing a foreign language in an attempt to sound sophisticated and intellectual!

    Now, even though I’m a writer and love words and language, that doesn’t mean that a well turned, simple piece of writing that expresses itself clearly is any less beautiful to me than a highly embroidered and embellished text. Personally I have more respect for someone who can explain a complex idea in simple language than I do for someone who dresses up a simple idea in complex language as a means to divert from the innate lack of substance…. Speaking about innate substances (and lack thereof), you still haven’t really explained to us what you base your practice as a chiropractor on since you claim not to believe in subluxations…so do you believe in this “innate” that you keep dodging questions about?

  11. Fifi says:

    Btw, here’s my definition of “siting” – people who get all their information from websites and wouldn’t know their way around a library if their life depended upon it. You do indeed seem to be a “siter”, as in someone who just googles and posts links with attractive headlines without even reading the attached information.

  12. nwtk2007 says:

    FiFi, you’re cute.

    Sarcasm, slang and poor spelling just don’t suit you do they.

    Us white trash southern dudes just tawk like that. (Did you know there is an inverse relationship between spelling ability and intellegence quotient?)

    If you will check my above post I explained my practice. I treat musculockeletal injuries: neck, back, shoulder, knee, etc.

    I take patients in as an entry level provider (history, exam, diagnostics and formulation of treatment plan) managing their care and providing treatment and referrals as needed.

    I employ both passive and active modalities as well as chiropractic manipulative treatment, if needed. I also work hand in hand with PT’s and ortho/neurosurgeons on a case by case basis, both pre- and post surgical as is required.

    You are right about using the internet. It is very handy and convienient. Libraries are inadequate, a long way away and essentially outdated. I am good about reading the studies when I can get access to them. In fact, I am currently reading the last posted reference by dadelus. I actually printed this one out so I could move around and read it in the clinic.

    Funny, you say I am pretentious yet to me it is you who is very full of herself and quite taken with your perceived intellegence.

    Believe me, I am neither sophisticated, cultured or all knowing. I have a deanky vocabulary and can’t spell worth beans. You are much the superior to me. Enjoy.

  13. Fifi says:

    I know I’m cute but my attractiveness is beside the point.

    I take no issue with people who just don’t know how to spell – it’s just pretentious language use that’s also incorrect that I find to be pseudo intellectual. I have no problem with people using slang – in fact, I’m a big fan of slang, patois and regional dialects). I just find it entertaining that you accuse others of being pseudo intellectuals while so obviously revealing a desire to be considered an intellectual yourself!

    nwtk – You keep avoiding HOW you treat patients. How DO you treat patients? You’ve said you don’t believe in subluxations (which most chiropractors do believe in because it’s what is taught in chiropractic schools), what DO you believe in? Do you believe in Innate? Do you condone doing neck adjustments?

  14. Fifi says:

    Do you base your diagnosis on what you learned in chiropractic school? What is “chiropractic manipulation” once you remove the concept of subluxations? What do you mean specifically when you say “passive and active modalities”?

    Btw, you come across as pretentious because you’re pretending to be something that you’re not, you clearly aspire to be intellectual but can’t quite reach that far. Just as you clearly aspire to taken seriously under the guise of EBM, even though you keep revealing your misunderstanding of EBM. I wouldn’t consider your language use pretentious at all if you stuck to what you know (be it white trash slang or colloquial) and didn’t put on your pseudo intellectual hat to try to elevate yourself (when you decry others as being pseudo intellectuals). You are both the pot AND the kettle it seems!

  15. daedalus2u says:

    Huh? You call a prospective cohort trial of 45,619 a “case study”?

    http://jasn.asnjournals.org/cgi/content/full/15/12/3225

    Who is saying “increased oxalate levels with kidney stone formation which is just not documented and has been pointed out as being a misunderstood myth”? No one that I have been able to find. You say it, with no citations, or from citations that don’t actually say what you are saying they say.

    If you applied the same “standard” of what is a myth to chiropractic, you would have abandoned chiropractic as a myth long ago.

  16. Fifi says:

    Just a little reminder of nwtk’s perspective on subluxations…

    “# nwtk2007on 04 Jul 2008 at 4:12 pm

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

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

  17. nwtk2007 says:

    daedalus,

    The reference you are referring to is a four year followup with a questionaire. A survey of sorts. It is interesting and I have not gotten all the way through it.

    The case study is this one:

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2235877

    The other link you gave was a list of links. I haven’t gotten to that one yet.

    Working on it.

    FiFi,

    Why are you so interested in my practice? Not all chiropractors treat the subluxation to free the flow of innate “energy” thru the nerves to heal the body, so to speak.

    You seem to think that all chiropractors think and do the same things because of the oral history of the field or some of the things taught in the schools. It just isn’t so.

    Daedalus, the ones who called it a myth I think were the MD’s at the orthomolecular web site and it was also a term used by an MD who was writing for a journal of nephrology. I didn’t wrtie it down. Keep looking and reading, you’ll come across it eventually.

    If I can get a chance I will hunt them up again for you.

    FiFi, if you want to learn the diff between passive and active modalities, just google the terms. I will detail for you my practice later.

  18. nwtk2007 says:

    And you are right FiFi. That is exactly what I said. Just trying to be objective about it is all.

  19. Fifi says:

    mwtk – Actually I’m interested in your definition since, as you propose yourself, there’s no actual consensus or agreed upon meaning for terminology amongst chiropractors. I’m interested in what your practice consists of specifically since you dismissed the connection between neck “adjustments” and stroke (and claim to treat neck injuries) – and showed no compassion or criticism of your fellow chiropractors for treating “subluxations”. I find it rather suspect that you avoid being clear and specific about what you actually do and believe.

  20. Fifi says:

    nwtk – From what you say, chiropractors sound like they just make up whatever they want and claim it’s chiropractice – aren’t there any professional standards at all? What chiropractors school did you train at?

  21. Fifi says:

    nwtk – If you were truly trying to be objective you wouldn’t base your beliefs upon your subjective experiences. To me it sounds more like you actually believe in subluxations but just don’t want your beliefs to be associated with the terminology of chiropractic theory. You want your magic cake to be a science cake and think changing the name will make it so!

  22. nwtk2007 says:

    Funny you should say that. The courts call EMS physical therapy if done by a PT but they call it chiropractic if done by a DC.

  23. nwtk2007 says:

    Wierd. The way they displayed the last two posts makes it look like you responded to me before I said anything.

    Well, you think I “believe in” subluxations and just don’t want to admit it. Hmm.

    Not true. But at Parker College in Dallas the “theory” of the “subluxation” was much more than just a vertebrae being “out of place”. In fact, we heard quite a few views of what the “subluxation” is or isn’t. The basic science guys would occasionally throw in some bits and pieces of anatomy, physiology and neurology that would, at least partially, substantiate or support some of the differing views of the “subluxation”.

    Some of the old timers talked about innate intellegence and some of the essoteric silliness that you guys associate with chiropractic as all encompassing the profession, but it was all phylosophy, not practical or applied to diagnosis, therapeutics or treatment.

    Now if you call a fixated joint a subluxated segment, then maybe in that sense manipulation does “remove” subluxations. It’s mainly semantics for those of us who were not religiously devoted to “belief” in something or other and viewed things from a more scientific position.

    I’m not sure “beliefs” is a term I would use for what I do in chiropractic practice.

  24. Joe says:

    Fifi on 18 Jul 2008 at 4:27 pm wrote “nwtk – From what you say, chiropractors sound like they just make up whatever they want and claim it’s chiropractice …”

    That is essentially correct. They have no standards. Even if a chiro eschews subluxations- one has no idea how s/he treats customers. the chiro license offers few constraints.

    They certainly don’t learn medical diagnosis in their schools. They have been known to treat joint pain, due to cancer metastases, with “manipulation.”

    Now, it is time for nitwit2007 to invoke his tuo quoque argument. However, substandard diagnostic ability is just that for MDs; whereas it is par for the course for chiros. Subluxations or not.

  25. Fifi says:

    nwtk – So are you claiming that what you do is based upon scientific evidence? Are you claiming to practice EBM?

    Parker School’s version of what chiropractic is…do you disagree with our alma mater or agree?

    “The chiropractic adjustment is intended to remove any disruptions or distortions of this energy flow that may be caused by slight vertebral misalignments called subluxations. Chiropractors are trained to locate these subluxations and then to remove them to restore the normal flow of nerve energy, in terms of both quality and quantity.

    The idea is that if the master system (the nervous system) is healthy and functioning well, then other systems under its control will also function in a more optimal fashion. Chiropractic is based on the belief that the same innate intelligence that can grow a single cell into a complex human being, made of billions of cells, can also heal the body if it is free of disturbances to the nervous system.”

    http://www.parkercc.edu/Chiropractic_defined_by_Parker_College_of_Chiropractic.aspx

    I notice that the store also sells “nutritional products”…

    http://www.parkercc.edu/parker_Share_products_bookstore_welcome.aspx

  26. Harriet Hall says:

    nwtk2007,

    Whatever you want to call it, subluxation or vertebral subluxation complex or subluxated segment, the definition is vague enough to allow chiropractors to call practically anything abnormal and use it as an excuse to manipulate anything they want to manipulate.

    Diabetes can be defined in terms that allow anyone to divide patients into diabetics and non-diabetics, and everyone can agree about it. Real subluxations can be seen on x-ray and measured so that all observers can agree on who has one and what the degree of displacement is. Whatever chiropractors are treating, it is not possible for anyone to divide patients into normal and abnormal so that everyone can agree.

    There are numerous accounts of the same patient going to different chiropractors and being told he has subluxations in different parts of the spine, or being told by 2 successive chiropractors that his left leg is longer and his right leg is longer.

  27. nwtk2007 says:

    From supplements to subluxations.

    Is it vitamin subluxation or vertebral C?

  28. Fifi says:

    nwtk – Yes, apparently your alma mater is quite involved in selling and promoting supplements as well as subluxations. You keep claiming you don’t engage in any of the practices that your alma mater promotes! This is one reason why I’m so curious as to what you actually DO since you claim not to believe or practice what your alma mater teaches and promotes!

    Apparently your alma mater does base what they teach on beliefs…

    “To become a doctor of chiropractic means accepting a focused philosophical stance – believing in the power of the body to heal itself, the right of the patient to receive comprehensive, wellness care and the expertise of the chiropractic physician to guide the way.”

    http://www.parkercc.edu/Index.aspx?id=201

  29. nwtk2007 says:

    FiFi, I hate to be an ass but I have quite a few Alma Maters.

    One promotes low cost education for urban students, one promotes the belief in Biblical Strict Interpretation even to the point of needing to be baptized for remission of sins, the other is a leader in molecular biology which was established by colleague’s of Delbrook (the father of molecular biology-not the father but the son), one promotes all disciplines, one once was a military college of agriculture and the one you mention, was Parker College of Chiropractic.

    Don’t quote their beliefs, even if, at all, they are the majority beliefs of the faculty. That is just stupid.

    Shall we look at all alma mater’s represented here?

    Get real.

    But since I am here, when PT’s do manipulation of the spine, what is it they are doing and why? What are the changes illicited by the manipulation? Is it effective as most would admit that CMT is effective for low back pain? What is going on physiologically when they do manipulation? Do they manipulate the cervical or thoracic spine? Have they not lobbied lawmakers for the right to do manipulation of the spine?

    Come on FiFi, can YOU answer this? Google is just a keystroke away.

  30. Fifi says:

    nwtk – You still haven’t answered whether you support the beliefs promoted by the school where you studied to be a chiropractor. Do you?

    Clearly it’s also relevant whether you believe in the “Strict Biblical Interpretations” of the other school you say you’ve graduated from (but don’t identify) since “strict bible interpretations” tend to include anti-evolution and anti-science beliefs.

    You also don’t identify the school where you claim you studied molecular biology. I will indeed unleash my google-fu to educate myself more fully about molecular biology and I will also discuss it with the biologists I know so as to profit from the expertize of people I know I can trust due to experience. The most cursory read of the info on Wikipedia (obviously not an entirely reliable source but a good place to start) doesn’t even mention Delbrook. Did your education in “molecular biology” come from a school that teaches “alternative science”? Is that why you won’t identify where you studied? C’mon, get real and be honest about where your credentials come from and the beliefs you hold!

  31. nwtk2007 says:

    Sorry FiFi, I misspelled it.

    Max Debruck, father Hans, (the brain of which Igor was sent to get for the monster in Young Frankenstein), was considered the father of molecular biology, specifically he is credited with the establishment of the, then, central dogma of molecular biology, about “information”, so to speak, flowing from DNA to RNA to Protein.

    We know it is more complex than that but that was then.

    I graduated with a masters in molecular biology from the University of Texas at Dallas in 1982. The Christian college was Abilene Christian Iniversity, bachelors, 1978. Getting old.

    ACU was interesting, freshman girls were the best (all preachers daughters) and I played a lot of tennis and studied while everyone was at church on Sunday mornings. In Abilene, Tx, you can do absolutely nothing all weekend and come Monday, feel like you didn’t miss a thing. Pretty good school but not as rigorous as UTD was back then.

    Initially, UTD was the Research Center of the Southwest, I think, and then became incorporated with UT and was mainly a grad school when I was there.

    Google on girl.

  32. nwtk2007 says:

    FiFi, I just ate so am energized, but tired from the heat of yard work. Fun though.

    Some of my instructors at UTD were very linked, so to speak, with many of the early greats. They all worked with Watson and Crick, although, they did not like Watson.

    Bremmer, was big on RNA polymerase. He claimed to have gotten fired by Delbruck, did his work on RNA polymerase, was approached by Delbruck for teaming up, but turned him down.

    Plasmids bear his initials, for example, pBr322 is a plasmid which carries resistance to ampicillin I think. The Br in the name stands for Bremmer.

    An Englishman named Clause, spelled wrong probably, was the first to clone a gene on to a plasmid, something related to insulin.

    Rupert was a physics guy who mathematically predicted that there must be something repairing DNA damage due to UV damage. He and another prof there, Harold Werbin, were the first to isolate a DNA repair enzyme, photolyase. It repairs thymine dimers formed by UV exposure, which lead to alterations in transcription and replication.

    Another was Demitri Lang, a german who worked with Kleinschimdt, an electron microscope pioneer. Most early micrographs linked to Kleinschmidt were actually done by Dr Lang. He is also credited with developing radar jamming for the Germans in WW II.

    Others were there also from the beginning. Amazing dudes to say the least.

    The story is that they came here because of massive funding from Texas Instruments and freedom to do what they wanted.

    Very hard school with unbelievable testing procedures. Some exams lasted over twelve hours.

    The Christian school was the result of being raised in the Church of Christ. All of my friends went there so I did. Just my junior and senior years. You really weren’t hammered with biblical belief though. They strived to be as thorough as any school in their science education. At the time, they claimed to have the highest acceptance rate into med and dent schools of all Texas universities.

    The belief thing has always been a struggle. Not really worth mentioning in this forum. I dealt with it pretty much the same way I did at Parker. But really, the faculty at Parker were much more “liberal” in essence, than the then president. Much more science oriented. Their basic science program was very good.

    What else you want to know?

    I am not into beliefs. Just what I think or others think. When someone says they believe, I pretty much don’t buy it. They never truly believe what they say they believe. If there was true belief, they would be very much different, no matter what it is they believe in.

  33. Fifi says:

    nwtk – Thanks for clarifying your previous misdirection. Sure your beliefs are worth mentioning in this forum since you advocate for non-EBM. It helps us to understand what you DO base your beliefs about medicine and clinical practices on if it’s not scientific evidence.

    Did the Christian school you attended that believed in “strict Biblical interpretations” apply that to science as well? Did you attend the school before the attacks on science and evolution by Christian schools began? Or do you consider creationism to be science?

    Those professors sound like really interesting guys, I’m sure I’d find them fascinating to talk to and their research sounds well worth reading up about. Clearly they’ve employed the scientific method to great benefit and do really interesting research. I notice you only speak about their experiments and achievements though, I’m not sure how that really relates to you or you having authority. What are your achievements in the field? Why did you give up science to pursue magical thinking? Thanks again for clarifying your misdirection, between the google-fu and discussing what I dig up with the biologists I know, I’m sure I’ll learn some interesting things.

  34. nwtk2007 says:

    FiFi, I do not intend to misdirect, as you say or to mislead.

    I am in favor of EBM but it should not be the end all to end all, nor does all in health care have to be grounded in science to the exclusion of all else. EBM is corrupt as well as much of what people call science is. Research should continue and new ideas investigated but there is more to health care and science than meets the eye.

    I have heard too many who claim to know what science really is only to contradict themselves and cannot be convinced otherwise. My parents and most of their friends are the same way about their religious beliefs and won’t look beyond those beliefs even one little bit.

    I don’t even like the word “belief”. When people “believe” something, they will listen no more.

    The christian school I went to taught the same biology and chemistry as you would find anywhere and kept their “belief” separate from the curriculum. You asked about creationism, they did not teach it in the school but it probably came up on Sunday morning in church. It is hard to know what the overall faculty “believed”. I think they just knew that we don’t know.

    And what makes you think I gave up science and now pursue magical thinking. I am not an extremist and shouldn’t be judged as one.

    You never answered my question, nor did anyone else. What is it that is going on physiologically when a PT or a DO or an MD performs manipulation and why would PT’s be so hot on making it a part of their package, so to speak.

    What I mean is, in the little that most will agree on, that manipulation of the lumbar spine is beneficial, what is going on there? Why do great pianists “pop” their knuckles. (Go to the Van Cliburn competion and witness the manipulations.) I would imagine they consider their hands to be solid gold.

    It’s just food for thought. The issue of spinal manipulation will not be settled by debate and hopefully chiropractic will expand their research. They have more than you know but it is never considered and is not a Google thing that one can find on the internet readily.

  35. Harriet Hall says:

    nwtk2007 said,

    “manipulation of the lumbar spine is beneficial, what is going on there?”

    How about stretching tight muscles, relieving muscle spasm, improving restricted range of motion? Is there any need to posit anything more?

  36. Harriet Hall says:

    nwtk2007 said,

    “EBM is corrupt as well as much of what people call science is.”

    Yep! That’s why we started this blog!

  37. David Gorski says:

    I disagree that EBM is “corrupt,” at least no more so than any other human endeavor and arguably less so.

    Is it imperfect, yes. Inadequate? Certainly. Not always well applied? Of course. Flawed at its very core in that it all too often discounts scientific plausibility? Absolutely. But “corrupt”? No, I can’t go along with that. And EBM is certainly better than the alternative, which is, ironically enough, the same sort of unscientific nonsense that goes under the rubric of “CAM.”

  38. Harriet Hall says:

    The concept of EBM has been corrupted by true believers who have made up their own definition of “evidence” to suit their own purposes. A prime example is a chiropractic textbook entitled “Somatovisceral Aspects of Science: an Evidence-Based Approach.” There isn’t a word in the book that you or I would accept as evidence.

    Science is being misused by true believers: instead of doing science to find out IF their pet methods work, they are co-opting science to try to demonstrate THAT the methods work.

    What this blog is trying to do is stick to the original uncorrupted meanings of EBM and SBM.

  39. Fifi says:

    nwtk – Having worked with some physical therapists as part of a team in a pain clinic – I’d say that, in my experience, the difference between a physiotherapist and a chiro (I’ve visited a chiro as a patient on the suggestion of a friend) is that physiotherapists ground their actions in the real world. They’re treating very practical, real world conditions – not “energy blockages”, not “subluxations”, not ambiguous “it could be a subluxation by any other name” stuff, no “kineosiology” or dowsing muscles (not to be confused with the legitimate study of motion called kineosiology), they’re not proposing themselves to be nutritionists and they have a consistent professional standard not some sort of Wild West where they’re not responsible for their actions. They don’t do neck adjustments that result in stroke either.

    So, while you’d like to be considered as legitimate like a physiotherapist even though you haven’t undergone training based in science (but rather in the philosophy espoused by your and other Chiro colleges that promote all kinds of questionable practices), that’s an unrealistic desire and ambition to have simply because you employ one or two of the same methods amongst the many others that are dangerous when the risk/benefit ratio is looked at, or just useless and based in magical thinking. If you want to be considered a physical therapist – get the education and accreditation same as physiotherapists have to do. There’s no reason you should be riding on their coattails or considered equivalent when you’re not the equivalent for the reasons noted above. It’s just one more way for CAM to try to sneak in as a legitimate therapy and you haven’t earned the right or attained the accreditation to be considered a physiotherapist.

  40. David Gorski says:

    What this blog is trying to do is stick to the original uncorrupted meanings of EBM and SBM.

    Thank you for your clarification, because your original comment certainly sounded as though you thought the whole concept of EBM, not just the bastardization of it that we all too frequently see, is corrupt.

  41. Fifi says:

    nwtk – Interesting that you accuse EBM of being corrupt when you’re busy trying to corrupt it! There’s certainly corruption in medicine as there is any any human endeavor, generally that’s not actually medical practice that’s based in evidence (so, medicine but not evidence based), that’s why there are various ways to hold doctors and medical institutions responsible for their actions. Chiropractice is corrupt from the roots on up (which ethical chiropractors who practice EBM seem quite able to acknowledge and question), it’s not based in science and it attempts to distort evidence and corrupt the definition of science, it promotes all kinds of questionable non-EB medical practices, and so on.

    It seems that you’re going the Tu coque route again (which I’ve probably misspelled), what I personally like to call the “you’re a dick too” defense (though coming from a dildo that’s a claim of authenticity that falls flat).

  42. Fifi says:

    That should have read…pardon the early morning punctuation issues!

    “So, while you’d like to be considered as legitimate as a physiotherapist – even though you haven’t undergone training based in science (but rather in the philosophy espoused by your and other Chiro colleges that promote all kinds of questionable practices) – that’s an unrealistic desire and ambition to have simply because you employ one or two of the same methods amongst the many others that are dangerous when the risk/benefit ratio is looked at, or just useless and based in magical thinking.

  43. David Gorski says:

    It seems that you’re going the Tu coque route again (which I’ve probably misspelled), what I personally like to call the “you’re a dick too” defense (though coming from a dildo that’s a claim of authenticity that falls flat).

    That’s perhaps the most hilarious retort to that particular logical fallacy I’ve heard. (It’s Tu Quoque, by the way.)

  44. Fifi says:

    Thanks for the correct spelling Dr Gorski (and glad you got a chuckle, I do each time I see Tu Quoque!).

  45. Fifi says:

    nwtk – “The christian school I went to taught the same biology and chemistry as you would find anywhere and kept their “belief” separate from the curriculum. You asked about creationism, they did not teach it in the school but it probably came up on Sunday morning in church. It is hard to know what the overall faculty “believed”. I think they just knew that we don’t know.”

    Really, you’re the one that claimed you went to a strictly dogmatic Christian school and you’re now claiming that the strict dogma had no influence upon the curriculum!!! You’re saying “it probably came up Sunday morning in church” – so exactly how do you “know” it’s a strictly dogmatic Christian school but “think it probably came up in church” and “think they just knew that we don’t know” (when clearly from the fact your using conjecture means you don’t actually know what your teachers believed or knew even though you have no evidence!). I’m highly skeptical about your ability to discern the difference between science and “alternative science” (meaning faith or belief based ideas).

  46. Fifi says:

    Eh, fingers type too fast for keyboard…damn technology! Punctuation errors, damn brain!

    “(when clearly the fact that you’re using conjecture means you don’t actually know what your teachers believed or knew and are speculating and asserting even though you have no evidence!)

  47. nwtk2007 says:

    FiFi, you’re too funny. Once again you are extrapolating on what I have said and incorrectly so.

    Certainly some of the faculty at ACU were creation believers and followed the strick interpretation of the bible. I am just saying that I don’t know what the majority of the faculty believed and that the subject of creation never came up in a science class. So yes, I am saying that it did not influence the curriculum.

    You say – “I’m highly skeptical about your ability to discern the difference between science and “alternative science” (meaning faith or belief based ideas).”

    Why, because I went to a Christian school? Find out for yourself. Write the faculty and ask them. They have graduated many who have gone on to become scientists and doctors. Based upon how it appears that you are viewing this, then they must not know the difference between science and alternative science. Check out their research programs, not that I was involved in any research there.

    As to it being a strickly dogmatic school, I didn’t say that, only that the school is essentially a Church of Christ affiliated school and the C of C is definitely into the strick interpretation of the bible. Don’t read too much into this.

    As to how do I know, I was there.

    SMU in Dallas is a Methodist school so do you think everyone who graduates there is Methodist or believes everything the Methodist church believes and teaches? What about other private universities?

    And thanks for your comment Harriett, about the benefits of spinal manipulation,

    “How about stretching tight muscles, relieving muscle spasm, improving restricted range of motion?

    I was wondering if the physiology behind the releif of muscle spasm is understood. How could manipulation stop or relieve a muscle spasm? Would it only apply to the lumbar spine? Also, what would be the importance of unrestricted range of motion in the health of the spine or recovery from an injury?

  48. Harriet Hall says:

    nwtk2007 said,

    “I was wondering if the physiology behind the relief of muscle spasm is understood. How could manipulation stop or relieve a muscle spasm? Would it only apply to the lumbar spine? Also, what would be the importance of unrestricted range of motion in the health of the spine or recovery from an injury?”

    Gee, isn’t it interesting that a chiropractor is asking those questions a century after chiropractic was invented? You are the supposed expert in all things musculoskeletal.

  49. Fifi says:

    Worth checking of vis a vis nwtk’s claims about his alma mater, written by another graduate of the school a couple of years ago…

    “…these issues and feelings are very much a part of the school where I did my undergrad, Abilene Christian University. I remember my general biology 2 class where the professor introduced our study to evolution. He did so sensitively, and also discussed briefly some theological issues, saying that his faith wasn’t conflicted by his understanding of science. One student, who sat right on the row in front of me, angrily asked a few questions and then sulked the rest of the class. It wasn’t easy for him to hear something which he viewed as incompatible with his faith.

    I think many Christian colleges and universities have really come a long way in how we approach the topic of evolution. Twenty years ago, Abilene Christian and many of these other places would not openly teach evolution in science classes (which shows just how sad things were). Today, there are lots of Christian institutions that have no problem with it.”

    http://www.ocellated.com/2005/12/19/christian-schools-and-evolution/

  50. Fifi says:

    As for your “I was there so I know” response – you didn’t say you “knew” anything – you said “I think” in such a way that it indicated you didn’t really know and seemed very much to be a way to give a wishy-washy response that skirted the question.

  51. Fifi says:

    Certainly all schools that adhere to strict biblical, koran or torah explanations of the world – including creationist myths – would also be suspect in the area of their science classes, particularly evolution and biology – particularly in the US where evangelical and Fundamentalist Christians have made a concerted effort to promote ID over evolution. Many of the pseudoscientific chiropractic philosophies (particularly the one about the Innate promoted by the chiropractic college you graduated from) dovetail quite nicely with ID – if not openly echo this idea.

  52. nwtk2007 says:

    Harriett,

    You don’t have to answer, but I have yet to meet a PT who could explain the physiology and neurology about manipulation and (or exercise) and their benefits. Sure they can give some pat answers, but nothing remotely close to anything beyond jargon. Especially nothing at the molecular level.

    Since PT’s are EB, as you say, then I thought their explanation about it, or yours, might be more credible. I also like hearing other points of view.

    FiFi, thanks for the link. I will check that out. And who knows about ID. I don’t really think it will fly for long. One thing I have never understood is why “beliefs” are such a big thing to people. Just believing doesn’t make it true, even subluxation theory or innate intel or religious doctrine, etc.

    People act like it is an afront that someone else would have the gaul to believe diferently. They become “offended”. Strange.

  53. Harriet Hall says:

    nwtk2007 said,

    “Since PT’s are EB, as you say, then I thought their explanation about it, or yours, might be more credible”

    Some PTs, DOs and some MDs use spinal manipulation therapy. There is evidence that it is as effective as other methods for relieving some types of back pain. We don’t know “how” it works, although there are at least 3 hypotheses. I certainly don’t presume to have an explanation: I was just giving you my best guess. I think we can pretty well rule out the explanation that it removes subluxations that impair the flow of Innate. :-)

    When evidence-based practitioners don’t know how something works, they say so. Chiropractors have an explanation for everything, usually a wrong one.

  54. Fifi says:

    nwtk – Clearly you do have beliefs by your own admission. You believe that antibiotics are what cured your sinus infections, even when informed that most sinus infections clear up on their own. You believe that the treatments you offer your patients work – you’re unclear about HOW they work but you do believe they work (despite it just being your subjective observation that they do, not any objective evidence). Putting aside the beliefs that you’ve admitted you hold here and pretending for a moment you don’t actually have any beliefs (you are undoubtedly unique amongst humans) – if you don’t hold any beliefs but believe that science is too corrupt to be trusted (and don’t believe or adhere to your chiropractice alma mater’s philosophy or beliefs), exactly what ARE you doing and BASED on what when you treat a patient? So far you seem to go with “it looks like it’s working to me, that’s proof it works!” – which seems pretty much to be based in a personal belief.

  55. Fifi says:

    Harriet – Have there been any studies showing that spinal manipulation does actually improve or relieve back pain? (Keeping in mind that placebo treatments are also often effective in treating pain and that some chronic pain patients quite enjoy dramatic procedures!)

  56. Fifi says:

    nwtk – Well I do speak like a Gaul sometimes, being bilingual. No doubt I also act like one too sometimes, or at least a Quebecoise. I’m not sure why you’re so galled by Gauls!

    I take no issue with people having different beliefs than me (and I make no outrageous claims to have no beliefs), I find it interesting and investigate all different kinds of belief systems. What I do take issue with is people proposing their beliefs are facts based upon no objective evidence or their subjective experience – or people trying to insert their religion into secular government and institutions (whether that be trying to legitimize Sharia law in Canada, enshrine Fundamentalist Christian beliefs in the US constitution or ban abortion). As long as you’re not hurting others with your beliefs and practices, it’s really none of my business if someone gets off on dancing naked in their backyard in homage to the moon goddess (or using their own money to pay for reiki or even a chiro – as long as they’re informed of the stroke risk in advance so are consenting to the danger). Hell, I may even join them since dancing naked in the moonlight sounds like quite a bit of fun if there aren’t too many bugs!

  57. nwtk2007 says:

    Previously -

    ####### Calli Arcaleon 16 Jul 2008 at 10:21 pm
    When you first described it, it sounded like a one-time-only event — sinusitus, got antibiotics, sinusitus went away. Indeed, without any outside information other than that, it is not possible to tell whether the antibiotics caused the infection to clear up. A lot of people don’t realize that, and it has led to an overuse of antibiotics. They had the sniffles, they took antibiotics, their sniffles went away. But if they weren’t tested, or if their symptoms were not very conclusive, it’s just as likely that they had a viral infection which their immune system dealt with, totally apart from the antibiotics.

    I know a woman who swears by antibiotics. She buys them bulk in Mexico and takes them at the slightest sign of a sniffle. That’s a fairly egregious example, but that’s the sort of thing I think most of us were thinking of when you brought up antibiotics.

    Now, in your most recent post, you’ve elaborated considerably and given plenty of good reason to conclude in your case that the antibiotics were responsible for clearing up the infection. You didn’t just go by the fact that a single infection went away when antibiotics were used; no, you have plenty more to go on. It’s perfectly reasonable to conclude that the antibiotics were a good choice. ################

    Well, at least someone here agrees that I have adequate reason think the antibiotics have, on multiple occasions, cleared up sinus infections. I “believe” they do and should be used in situations where the infection seems to be persisting and causing increasing complications or potential risk to the patient based upon med history and disease progression.

    But you now say that you do not “believe” anti-biotics cure sinus infections? Now I would ask the same of you that you have asked the subluxation chiro: if they have no effect then why subject the patient to the risks of adverse side effects?

  58. nwtk2007 says:

    #####I’m not sure why you’re so galled by Gauls! #####

    Very good. Got me.

  59. Fifi says:

    nwtk – “if they have no effect then why subject the patient to the risks of adverse side effects?”

    Good question. One reason is that patients (such as yourself) become convinced that they NEED antibiotics – this led historically to doctors over-prescribing. A medical practice not based in evidence that’s no longer done because the evidence has shown it’s a bad idea. Some people just love pills and don’t feel as if they’ve been treated properly if they’re not prescribed something. Clearly you fall into this category!

    In your case you may or may not have needed the antibiotics – whatever the case, you BELIEVE they worked and kept repeating your actions based upon this belief thereby reconfirming to yourself your belief. Your inability to see how anecdotal, subjective evidence isn’t the same as solid evidence is really odd for someone who claims science is corrupt since it’s the most basic and common corruption out there. Anecdotes, myths and subjective observations can serve as inspiration or the basis of a hypothesis, they’re clearly not the same as properly researched evidence and fall more into the category of beliefs or ideas until proven or disproven.

  60. Fifi says:

    nwtk – Um, you’ve kept repeating “gaul” for “gall” (which is kind of hilarious considering that it’s related to biology!) even though it’s been pointed out to you before.

  61. Calli Arcale says:

    ntwk2007
    Well, at least someone here agrees that I have adequate reason think the antibiotics have, on multiple occasions, cleared up sinus infections. I “believe” they do and should be used in situations where the infection seems to be persisting and causing increasing complications or potential risk to the patient based upon med history and disease progression.

    But you now say that you do not “believe” anti-biotics cure sinus infections? Now I would ask the same of you that you have asked the subluxation chiro: if they have no effect then why subject the patient to the risks of adverse side effects?

    Perhaps I wasn’t very clear. I’m not saying I “believe” antibiotics cure sinus infections. I’m saying it’s reasonable to conclude that the antibiotics helped you because you have a significant amount of evidence to support that case. So it’s not comparable to a patient saying they believe that chiropractic helped their sinus infection just because the sinus infection went away after they had an adjustment.

    If an antibiotic has no effect, then absolutely there is no reason to subject the patient to it. Most colds are viral, and so antibiotics will do absolutely nothing to help. But antibiotics, like practically everything, have risks. The most common include diarrhea and fungal infections, neither of which are much fun. (If nothing else, it’s a waste of money to take antibiotics for your average run-of-the-mill rhinovirus.)

    Physicians vary, and fortunately, awareness has been improving. But some are still all too willing to hand out antibiotics prescriptions, for a variety of reasons, most of them well-intentioned.

  62. nwtk2007 says:

    I know that Calli. But you did agree it there was enough done in my case to reasonably conclude that the antibiotics helped get rid of the infection.

    As to the viral thing, I think most people know not to treat viruses with antibiotics. Most, by sinus infection, mean a bacterial infection. We definitly confirmed mine was bacterial.

  63. Fifi says:

    nwtk – How or why do you believe that antibiotics treating a bacterial infection you had is somehow equivalent to your belief that what you do as a chiropractor works because you have subjectively observed that what you do to make your living is “working”?

  64. Harriet Hall says:

    Fifi asked,

    “Have there been any studies showing that spinal manipulation does actually improve or relieve back pain?”

    Yes, that’s what I said: “There is evidence that it is as effective as other methods for relieving some types of back pain.” There is no evidence that it is superior to other treatments, but for patients who prefer it it is a perfectly reasonable option.

    A Cochrane review concluded: “This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.”

  65. Harriet Hall says:

    nwtk2007 said,

    “We definitly confirmed mine was bacterial.”

    How did you confirm it? The study I cited was about bacterial sinusitis as diagnosed on clinical grounds by general practitioners. For those cases, antibiotics were not superior to placebo. For other cases of bacterial sinusitis diagnosed by more stringent criteria by ENT specialists, antibiotics are effective.

  66. nwtk2007 says:

    I saw a resp specialist, as I previously stated, who had it cultured. He did a swab of some drainage flowing down the back of my pharynx and I “produced” some really fowl looking and ultra fowl smelling “yuck” for him. He said he could tell it was staph just from experience, and I guess the culture he had done confirmed it.

    He put me on cipro for six weeks. He said the 10 day plan doctors were using back then was a prescription for return infections and bacterial resistance. That was in 1984 I think. It was a good two years before I had it again.

    He also felt that one could also distinguish between rhinitis and sinusitis by the clearance of the nasal passages in sinusitis. He took X-rays also although I did not get to see them and was not told the results.

  67. nwtk2007 says:

    FiFi asks – “How or why do you believe that antibiotics treating a bacterial infection you had is somehow equivalent to your belief that what you do as a chiropractor works because you have subjectively observed that what you do to make your living is “working”?”

    I never ever implied that there was any connection between antibiotics and what I do in any shape, form or fashion.

    I started out by being pro – One Single Vitamin , Vit C, and that apparently made me pro Big-Vita.

    The subject of antibiotics came up and I suggested it might be too late to undo the damage to humanity because of the selection pressure producing more people with less natural immunity to bacterial infections and thus, I became pro Big Pharma.

    Harriett pointed out that I was a chiro and asked why I didn’t just eliminate the subluxations from my spine and I pointed out that I don’t treat subluxations.

    I then, according to this forum, became incapable of distinguishing good science from voodoo science, was directed that correlation is not causation, asked about my “beliefs” and to be honest, roasted for being a chiro, anti-biotic beneficiary and vitamin C promoter. Accused of various things like not caring for my patients, not knowing how to treat them, giving bad advice to them, running a faith based practice, etc.

    It is interesting, in that I think antibiotics are good for infections and that sometimes are very necessary, this forum has all but stated that any success from treatment with antibiotics was unnecessary exposure to the drug’s side effects and not needed; that bacterial sinus infections will resolve on their own with out antibiotic intervention.

    If I state support for other medical treatments will this forum counter that they are really not necessary treatments; their counter argument as much from their anti-chiro and anti-Alt bias as from their deep knowledge of the EBM that supports that medical treatment’s use?

  68. nwtk2007 says:

    Previously –

    ######nwtk – “if they have no effect then why subject the patient to the risks of adverse side effects?”

    FiFi – Good question. One reason is that patients (such as yourself) become convinced that they NEED antibiotics – this led historically to doctors over-prescribing. A medical practice not based in evidence that’s no longer done because the evidence has shown it’s a bad idea. Some people just love pills and don’t feel as if they’ve been treated properly if they’re not prescribed something. Clearly you fall into this category! ##########

    I must have missed this one. Again, I have benefitted from antibiotics and am convinced, with good cause, that they have prevented me from extreme illness and who knows what else. Admitted to resorting to antihistamines in an effort “not” to have to resort to the antibiotics, have not had to use either for well over a year now, I like and have gotten good benefit from vit C supplementations and thus:

    ——– I clearly fall into the category of a pill lover. ———-

    OK, fine.

  69. nwtk2007 says:

    Previously –

    ######Harriett said- “Some PTs, DOs and some MDs use spinal manipulation therapy. There is evidence that it is as effective as other methods for relieving some types of back pain. We don’t know “how” it works, although there are at least 3 hypotheses.”#############

    I would like to hear what those hypotheses are.

    Do you really “not” know how it works?

    Is there any reason to think that it would not have the same physiological effects elsewhere in the spine or the appendicular skeletal system?

    Modifying the technique and eliminating extension combined with flexion, could we reasonably expect the same results from manipulation in the cervical spine as we have found in the lumbar spine?

  70. Harriet Hall says:

    nwtk2007 said,

    “It is interesting, in that I think antibiotics are good for infections and that sometimes are very necessary, this forum has all but stated that any success from treatment with antibiotics was unnecessary exposure to the drug’s side effects and not needed; that bacterial sinus infections will resolve on their own with out antibiotic intervention.”

    That is not at all what I said. Go back and read the article I cited. Some infections require antibiotics; others don’t.

    Most children’s ear infections will resolve without antibiotics, but some won’t. There are published guidelines about when it’s safe to withhold antibiotics and observe the child and when it is important to prescribe them.

  71. Harriet Hall says:

    nwtk2007 said,

    “I would like to hear what those hypotheses are.”

    You ought to know far more about that than I do. They are described in the chiropractic literature.

    As for why spinal manipulation treatment might work better in the lumbar spine than in the cervical spine, the muscles and bones are different sizes and shapes, and there are a lot of other possibly confounding factors. I can only guess. As a chiropractor who does those manipulations, you ought to have a better idea than I do as to why the literature supports lumbar adjustments but not cervical adjustments.

  72. nwtk2007 says:

    Harriett – “You ought to know far more about that than I do. They (hypotheses of how spinal manipulation does what Harriett has said it does) are described in the chiropractic literature.”

    I doubt if PT’s, DO’s or MD’s use chiro literature as reference for how something they do works.

    Therapeutic exercise works for literally all areas of the spine and musculoskeletal sytem, despite the possible “confounding” factors you mentioned. Why would one think that it would be different for manipulation?

  73. weing says:

    nwtk2007,
    Cipro wasn’t available in 1984. Methinks your memory is playing tricks on you.

  74. nwtk2007 says:

    You could be right. It was a long time ago.

  75. Harriet Hall says:

    nwtk2007 said,

    “I doubt if PT’s, DO’s or MD’s use chiro literature as reference for how something they do works.”

    They can’t, because the literature doesn’t show how it works. All it can offer is hypotheses.

    “Therapeutic exercise works for literally all areas of the spine and musculoskeletal sytem, despite the possible “confounding” factors you mentioned. Why would one think that it would be different for manipulation?”

    You’re the manipulation expert – you tell me. The fact is that the data support lumbar manipulation but not cervical manipulation. What matters is whether it works, not what we think or whether we understand why.

  76. nwtk2007 says:

    I can apprectiate your position Harriett. If you admit that we know how it works then it would be hard to deny that it is effective when applied to the cervical spine and the rest of the appendicular skeleton.

  77. Fifi says:

    nwtk – The physiotherapists I worked with – who specialized in chronic pain related injuries and treatment – didn’t consider exercise and any hands-on treatment they provided as being the same thing. Clearly they’re quite different in many ways – this is obvious even to someone without training – do you not understand this? Or is this yet another situation where you’ll claim you’re “testing” the doctors here when you say something that’s incorrect or misleading, or propose something silly? And, of course, slither around actually stating your beliefs and what they’re based upon…so far you’ve denied you base your practice on your education as a chiro (or pretended you were taught something different than what the school proudly declares as their driving philosophy!) and you’ve claimed EBM and science are corrupt (apparently because they don’t support the beliefs you claim you don’t have), so what DO you base your treatments on?

    The reality is that Physiotherapists have a different training that Chiropractors do – no talk of the Innate and magical philosophy and attributing disease energy blockages, no shifty “subluxations by any other name” kind of dancing around definitions and trying to leave the door open for mystical energy medicine under the pretense of being “open minded” or “objective” (it’s odd you don’t recognize and can’t even acknowledge your own bias!), no sketchy pretending that what they do is something other than what they do (or is just like what someone with different training does!). In my experience physiotherapists are extremely practical and down to earth people – though I’m sure they come in all flavors – they also don’t try to pass themselves off as doctors or do diagnoses or treatments outside of their specialty (nor do they sell supplements). For all your talk and bluster you’re not actually dropping any knowledge! (That would be colloquial for “you’re not actually sharing or showing any knowledge”.) Physiotherapists who treat chronic pain and injuries also don’t usually work in isolation – nor are they the diagnostician (though their observations of the patient are taken into consideration). I’m curious, do you call yourself a doctor?

  78. Harriet Hall says:

    nwtk2007 said,

    “If you admit that we know how it works then it would be hard to deny that it is effective when applied to the cervical spine and the rest of the appendicular skeleton.”

    That’s nonsense. You don’t know how it works. The subluxation/Innate hypothesis has been rejected, and the chiropractic literature is looking for a better one and has at least 3 competing hypotheses with no good evidence to support any of them yet.

    I don’t deny that manipulation is effective in the cervical spine. I showed the evidence that it is no more effective than gentle mobilization. Since gentle mobilization is safer, there is no justification for neck manipulation.

  79. nwtk2007 says:

    FiFi, I am referring to therapeutic exercise, not just exercise. Obviously quite different from exercise.

    I do find it interesting that Harriett says it doesn’t matter how something works and even says we don’t know how manipulation works to do the things she says it does. EBM is fine and I really don’t contest it (except to say that it should not be the end all to end all), but I would think that there would be some consensus about how things work at a physiological and molecular level before employing it even if it appears to be EBM.

    Even EBM supported treatments have to have some science behind them.

    To me harriett is contradicting herself.

    And Harriett, you keep referring to me with comments about innate and subluxations. I don’t treat subluxations nor do I do things to release innate intellegence, what ever that means.

    FiFi, you’ve given me a lot about PT’s for what ever it’s worth. Why, I don’t know.

    What do I base my treatments on? Medical necessity. In order to do that, I have to understand why something works and why I would think a patient would benefit from it. So, always, medical necessity and what is in the patients best interest to treat their injury.

    You know, just speaking from a physiological stand point it is not really hard to understnd why therapeutic exercise is benefitial and it is equally clear how manipulation benefits the recovery of the injury and how it does so.

    I guess yours and Harrietts response to some of my questions indicates that you might actually be afraid of stating a case for manipulation of other parts of the spine and are thus reluctant to admit what you should actually know about the subject.

  80. Harriet Hall says:

    nwtk2007 says,

    “I would think that there would be some consensus about how things work at a physiological and molecular level before employing it even if it appears to be EBM.”

    Not at all. When we adopted penicillin it was because it clearly worked, although we had no idea what was happening at the molecular level.

    “Even EBM supported treatments have to have some science behind them.”

    Yes, they have to have science showing THAT the treatment works, but they don’t have to have science showing HOW they work. That can come later.

  81. Harriet Hall says:

    nwtk2007 said,

    “And Harriett, you keep referring to me with comments about innate and subluxations. I don’t treat subluxations nor do I do things to release innate intellegence, what ever that means.”

    I mentioned subluxations and Innate only as previous hypotheses that were no longer viable. There are at least 3 other hypotheses currently under consideration in the chiropractic literature. Do you know what they are? Which one do you think is the most likely?

  82. Harriet Hall says:

    nwtk2007 said,

    “I guess yours and Harrietts response to some of my questions indicates that you might actually be afraid of stating a case for manipulation of other parts of the spine and are thus reluctant to admit what you should actually know about the subject.”

    This is reprehensible ad hominem bull spit.

    I’ve told you what the evidence says. You’ve offered nothing to show that my interpretation of the evidence is wrong.

  83. nwtk2007 says:

    “This is reprehensible ad hominem bull spit.”

    Dang it, now my kids can’t read this.

    What are these 3 other hypotheses that are in chiro texts. What the heck is a chiro-text?

    I am talking about the physiology of why manipulation works. It does, you said so your self. There must be some physiology behind it or it must be magic.

    We know the physiology now don’t we Harriett. My question is, despite those “confounding factors, why wouldn’t we expect manipulation to work in the cervical spine as well as in the extremities. In terms of physiology, why would you think those “confounding factors” would be confounding and result in less or no benefit from manipulation in those other areas?

    We’re not talking penicillin here or about something that is not fairly well understood. We are talking about some basic human physiology thats been around since the 80′s or even before. Based upon that and what we know, why does it work in the lumbar spine and why would you think it wouldn’t in other parts of the spine and extremities?

  84. daedalus2u says:

    nwtk2007, a large part of the physiology at work is the physiology of the placebo effect. This is not well appreciated because what is a placebo and what is not a placebo can be difficult to ascertain. It is difficult to separate the physiology of the placebo effect from other aspects of physiology because the placebo effect is mediated through nitric oxide and it is primarily nitric oxide that couples all of physiology together. NO is the signaling molecule that cells use to broadcast their metabolic state to adjoining cells. Neighboring cells pick up that NO signal and modulate their activities such that they are in sync with neighboring cells.

    Neurogenic production of NO and of superoxide allows the CNS to modulate the physiology of the peripheral tissue compartments. Low NO turns on the “fight or flight” state and turns off healing. High NO turns off the fight or flight state and turns on healing. There is a very wide range of different physiology involved in both of those states; they are a diverse spectrum, different in each tissue compartment.

    Because NO physiology is what causes all of physiology to work together in sync, a disruption to NO physiology can cause virtually any symptom in virtually any organ or tissue compartment. The usual disruption to NO physiology is low NO. Low NO mimics the effects of stress, which are well tolerated in the short term, badly tolerated in the long term. High NO is only seen very rarely. Essentially the only example is septic shock. Septic shock is poorly tolerated in the short term, and (if you survive) well tolerated in the long term (if proper NO physiology can be restored).

    Because NO is what keeps tissue compartments “in sync”, disrupted NO physiology eventually involves multiple tissue compartments. Which tissue compartment fails first is a detail of that individuals idiosyncratic sensitivity to low NO.

    No one pretends to understand physiology enough to be able to explain things such as healing rates and why low stress aids in healing. The answer is as complex as physiology, which is vastly more complex than we understand. As limited as our knowledge is, we do know that some ideas are incorrect. As Harriet has pointed out numerous times, the idea of subluxations as chiropractors use it is wrong. The idea of 4 humours was wrong too. When scientists find an idea is wrong, they modify it until it is correct, or if it can’t be modified to correspond with reality, they abandon it.

    That is the difference between EBM, SBM and CAM. When EBM and SBM find a treatment modality doesn’t work, they modify it until it does work, or they abandon it. When CAM finds a treatment modality doesn’t work, they look for an uncontrolled anecdote where it seems to work and ignore the well controlled studies which show it doesn’t.

  85. Harriet Hall says:

    nwtk2007,

    I am really losing patience with you.

    You are the chiropractor, yet you keep asking ME what the hypotheses are for how manipulation works. You are the one who should be telling us what they are and which one you think is most likely.

    You seem not to be familiar with the chiropractic literature, and when I mention it you ask what a “chiro-text” is. (!?)

    You say there must be some physiology behind manipulation. Of course! I completely agree! But I don’t think anyone understands that physiology yet. Do you? If so, please share your knowledge with us.

    I said that manipulation iS effective in the neck, just not as safe and not more effective than gentle mobilization. Yet you appear not to have registered that, and you continue to ask “why does it work in the lumbar spine and why would you think it wouldn’t in other parts of the spine?”

    You keep making the ridiculous argument that we have to understand “how” something works before we can use it.

    I don’t think you are reading carefully or thinking clearly. This discussion is going nowhere and is not pertinent to the topic of vitamins.

  86. Joe says:

    nwtk2007 on 22 Jul 2008 at 7:05 pm wrote “We know the physiology now don’t we Harriett.”

    Apparently, we (as in: nwtk) do not. Lurking somewhere inside me is a course called “Quackery 101″ which teaches quacks how to dodge reality. One principle is to raise questions rather than making concrete statements. Another is plausible denial (e.g., “I don’t believe in subluxations”).

    Any chiro advice on health care is dubious, that includes vitamins. The minimum requirements for a DC do not include a real education in health, and I do not trust them to learn it on their own.

  87. nwtk2007 says:

    In Harriett’s own words – “This is reprehensible ad hominem bull spit.”

    Joe, having failed at trying to be a chiro, now spends his days “trolling” about looking for any opportunity to take a jab a the profession which he was too stupid to succeed at.

    And Harriett, you are the one who brought up chiropractic in this forum about supplements, not me.

    I came in with a bit about vit C, someone said it was essentially placebo, somehow antibiotics came up and someone said I really hadn’t been helped by antibiotics and then you came up with some analogy about chiropractic. I am just following through with that, but I’ll drop it. I am beginning to think you really don’t know the physiology associated with manipulation.

    Daedulus says it’s all about NO, which apparently is lost through the washing of bacteria from the scalp and provides the essence of the placebo effect.

    As far as supplementation goes, I see a lot of your points, but the benefits of vit C supplementation, beyond what can be gotten from the diet, is pretty clear to me and far an away out weighs the questionable, minuscule risk that has been suggested here.

  88. Joe says:

    nwtk2007 on 23 Jul 2008 at 7:46 am wrote “Joe, having failed at trying to be a chiro, now spends his days “trolling” about looking for any opportunity to take a jab a the profession which he was too stupid to succeed at.”

    Even if you are a woman, I am not flattered that you fantasize about me (but, when you obsess about me, I hope you imagine a man who is 6′ tall, blond with blue eyes and washboard abs).

    I don’t know who you are, and I do not care. When you promote your ignorance in particular, or chiro in general, I respond to that.

    nwtk2007 on 23 Jul 2008 at 7:46 am wrote “… the benefits of vit C supplementation, beyond what can be gotten from the diet, is pretty clear to me …”

    So, you clearly do not understand what you have been told.

  89. Fifi says:

    Joe – Yes, you sure are a troll hanging out here to discuss EBM, medicine and science on a science-based medicine blog!!! Unlike the chiropractors who come here to promote non-evidence based whatever-the-hell-it-is-they-do (nwtk apparently can’t actually describe what he does or what evidence/beliefs it’s based upon) and to “troll about looking for any opportunity to take a jab at the profession which they were too stupid to succeed at”. Clearly nwtk desperately wants to be considered a doctor, or at the very least a physical therapist. Oh, and an expert on vitamin C even though he revealed a woeful ignorance about the synergistic effects of vitamins and minerals on each other (you know, basic biochemistry…kinda odd since he claims to be molecular biologist as well as a chiro! Almost as odd as pec’s claims to have a PhD in Cog Sci even though she considers her subjective experiences to be acceptable scientific evidence – as does nwtk!).

    So shame on you Joe! How awfully trollish of you to hanging out on a science blog, gasp, to discuss science!

  90. nwtk2007 says:

    FiFi, your just mad because I represent a group of chiropractors who do not do what you think ALL chiropractors do.

    Too bad girlfriend.

    I did look into PT school but was talked into chiropractic by, of all people, a practicing PT.

    Do I desparately want to be considered a doctor? Well unfortunately for you and Joe, I am, but I would rather teach. There’s just not enough money in it with two kids and one income.

    When did we ever discuss the synergistic effects of vitamins and minerals? Are you talking about that extremely weak link between kidney stones and vit C? Near as I can tell from the “big” paper/study sited (a survey), low levels of vit C have a very weak connection (not cause of) with kidney stones. An increase of less than two per thousand. The “connection” drops off and disappears at levels above 400 mg per day or there abouts (doing this from memory from the pape and too lazy to get up and get it), beyond that no correlation at all and never even that correleation in men above 60yoa.

    Is that what you were talking about?

    And yes, I am a molecular biologist and a chiro.

    In fact, we were probably one of the first to show any type of antioxidant activity in vit C and E. We didn’t pursue it too much. We called them free radical traps back then.

    And since you keep asking FiFi, I also teach college A & P for science majors (pre-med, pre-dent, pre-PT and pre-nursing) and have written more than a few letters of recommendations for prospective PT students and med students.

    How about you FiFi, and you too Joe? What do you guys do and beleive?

  91. Fifi says:

    nwtk – What I’m talking about is your ridiculous claim that Joe is a troll for bringing up science on a science-based medicine blog. A claim made all the more ridiculous when coming from a chiropractor who won’t define what they do and believe (though you claim it’s not what your Alma Mater promotes so it ain’t chiro but it ain’t medicine…who knows what he’s doing!), who still doesn’t understand (or acknowledge obviously!) the synergistic nature of vitamin C and iron, and who can’t even acknowledge that subjective observation isn’t scientific evidence (though it may be something to base speculations upon), not to mention that the fact that you make a living providing chiropractic services so there’s clear bias and conflict of interest issues!

  92. Fifi says:

    Since I don’t provide health care treatments, what I do and believe isn’t particularly relevant since it doesn’t put anyone’s health at risk. Even when I did work in a pain clinic, my personal beliefs weren’t particularly relevant since I wasn’t diagnosing people or providing medical treatments, I was merely facilitating various lifestyle changes (and helping people understand the mind/body connection) and worked as part of a team that included doctors, psychologists and physiotherapists (and under their supervision and guidance).

    You’re the one making claims to expertize (above and beyond the seasoned professionals who blog here) and to have some mysterious knowledge (unknown to science) so it’s up to you to provide evidence since you’re making the claims. As someone who makes claim to be a scientist, surely you’re aware that the burden of proof lies with the person making the claims!

    All of this is, of course, irrelevant to the fact that you’re the one trolling a science-based medicine blog so your accusations that Joe is a troll are really ludicrous. Or do you live in some “alternative” reality where you consider Joe a troll for talking about science on a science-based medicine blog?

    As for being a representative of a group of chiropractors who practice EBM – I have seen this group discussed here but you hardly seem to be one of them or to reflect what they promote via their group or website (since you promote the kinds of neck adjustments that can cause arterial tearing and stroke!). Please do inform us of what group of chiropractors you do represent because it really would be a shame if people confused you with the group of EB chiropractors who speak out about neck adjustments and recognize the stroke risk!

  93. nwtk2007 says:

    FiFi,

    Joes not bringing up science, he is chirobashing because he hopes to get out of his student loans if chiropractic goes away.

    Joe has utterly failed at chiropractic and wouldn’t know science if it kissed him on the ass.

    And I don’t think you actually read all of my post above before you posted your knee jerk response.

  94. Fifi says:

    Sure I read your post (please stop projecting your own reading habits onto me). Joe brings up plenty of science and even if he didn’t it wouldn’t change the fact that you’re not only a troll but perhaps a professional one (since you now claim to represent a group of chiropractors who share your beliefs – which apparently aren’t based in EBM OR chiropractice! – though your refuse to be open about what you DO believe and actually practice – apart from saying you’re the equivalent of a physiotherapist!).

    The fact that your only response is to claim Joe is a failed chiropractor is just silly since it has no bearing on your being here to be a troll. Particularly since you’re the one that seems to have a problem grasping the basic premise of what is and isn’t scientific evidence (not that I doubt this would get in the way of teaching “science” in the US, or “alternative science” and ID at some Fundamentalist or chiro school).

  95. nwtk2007 says:

    This post is about supplements, right? I brought up a point about vit C when I first posted here, right?

    Is that trolling FiFi?

    The forum shifted to antibiotics and I commented on that.

    Harriett brought up the chiro crap.

    I am just staying up on the forum topic.

    That is not trolling.

    Disagreeing is also not trolling FiFi.

    Popping in from time to time to bash chiro is trolling, no doubt about it.

  96. Joe says:

    nwtk,

    Many years ago, a boy (living in a home for retarded children) asked me to help with a science project. (I will help any student interested in science.) When the project was concluded, he asked the critical question- how we can assure that it was, in fact, successful. So, I took him to my college and ran a test using a $250k machine, which verified his claim.

    The difference between you and that boy is that he was a critical thinker. You haven’t asked the simplest question- how can you verify your claim about vitamin C.

  97. Fifi says:

    nwtk – You don’t just disagree or question (I’d have some respect for you if you did but you’re not an inquiring mind!), you’re here representing a group of chiropractors (or so you claim) and being disruptive to discourse (including calling other members “trolls” because they don’t agree with you and are here because they have an interest in science-based medicine). You are also downright rude to the authors of the blog and evade direct question. You also consider your subjective opinion and observations about what you make a living doing is scientific evidence! Your words and actions really speak for themselves! :-)

  98. Fifi says:

    nwtk – So who is this shadowy group of chiropractors you represent? And what do you believe and based your practice on if it isn’t what your chiropractic college promotes and it isn’t EBM?

  99. nwtk2007 says:

    Funny story Joe.

    You know, earlier on this thread, I was asked essentially the same thing about my experience with antibiotics and sinus infections.

    Calli finally read carefully enough to admit that I was atleast reasonable in my conclusion that the antibiotics had helped the sinus infections.

    Bearing that in mind, I have essentially the same verification about vit C. OK, maybe not quit that much.

    Antibiotics are backed by a great deal of evidence showing what they do. It is essentially the same for vit C, at least in terms of it’s need in maintaining the strength of connective tissues, which will break down if over stressed repetitively. The result of the break down is microtrauma, low levels of inflammation (swelling, tenderness and pain).

    Since supplementing with vit C, those S/S associated with microtrauma lin tissues stressed during activities like running and racquetball have greatly deminished and all but gone away.

    Harriett said correlation does not mean causation. I suppose she is right. She said the same thing about antibiotics.

    I can only “verify it” based upon what is known and my experience. I would personally rather not stop taking the vit C just to see if the S/S I have related to you come back.

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