Articles

The Problem with Chiropractic NUCCA

EDITOR’S NOTE: Dr. Atwood, who would normally be scheduled to post today, is on vacation. Consequently, we are publishing the following guest post by Samuel Homola, D.C., a retired chiropractor who limited his practice to science-based methods and spoke out against the irrational and abusive practices of his colleagues. He is the author of Inside Chiropractic and Bonesetting, Chiropractic, and Cultism and co-author with Stephen Barrett of the skeptical Chirobase website, a division of Quackwatch) .

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In 1895, Daniel David Palmer, a magnetic healer, announced that “95 percent of diseases are caused by displaced vertebrae; the remainder by luxations of other joints.” He opened the first chiropractic school in Davenport, Iowa—the Palmer Infirmary, which offered a three-week course of instruction.

In 1906, D.D. Palmer’s son, Bartlett Joshua Palmer, a 1902 graduate of the Palmer Infirmary, took over his father’s school. In 1924, claiming that “subluxation” of any vertebra would cause disease by compressing nerves in the intervertebral foramina, B.J. Palmer introduced the  “Neurocalometer,” a thermocouple device guaranteed to locate nerve-pinching vertebral subluxations. Chiropractors were told that if they did not use this “infallible” device to measure heat differentials on the skin over the spine, they could not competently locate and adjust a subluxation. But the Neurocalometer was not for sale. Chiropractors were forced to lease the instrument and then pay a monthly rent. 

In the early 1930s, after nearly three decades of teaching that subluxations anywhere in the spine can cause disease, B.J. Palmer announced that he had found the one and only cause of disease: subluxation of the atlas. Palmer concluded that subluxation of a spinal vertebra below the axis was not possible because vertebrae below that level were bound together by intervertebral discs and interlocking joints. Students at the Palmer School of Chiropractic were not permitted to adjust the spine below the axis until 1949 when full-spine techniques were once again included in the course of instruction. 

B.J. Palmer’s “hole-in-one” (HIO) technique for adjusting the atlas and the axis remained popular among certain factions of the chiropractic profession. According to the 2005 edition of Job Analysis of Chiropractic, published by the National Board of Chiropractic Examines, 25.7% of practicing chiropractors include the “Palmer upper cervical/HIO” technique in their adjustive procedures.      

The NUCCA Club

Members of the National Upper Cervical Chiropractic Association (NUCCA) specialize in adjustment of the atlas, using the procedure as an exclusive treatment for a great variety of ailments. “The focus of the NUCCA work is the relationship between the upper cervical spine (neck) and its influence on the central nervous system and brain stem function. It is this relationship that affects every aspect of human function from the feeling sensations in your fingers to regulating hormones, controlling movement, and providing the ability to hear, see, think, and breathe.” The mission of NUCCA is defined as “Maximizing the human health potential as associated with the reduction of the Atlas Subluxation Complex (ASC).” (nucca.org)

With such a broad and inclusive definition, NUCCA practitioners adjust the atlas as a treatment for ailments ranging from allergies and ear infections to multiple sclerosis and epilepsy. (See http://www.ucc-ny.com for a list of conditions treated by NUCCA practitioners.)

NUCCA Procedures

In an effort to locate “minor and pain-free atlas subluxations” that allegedly cause “brainstem ischaemia” and compromise brainstem neural pathways, NUCCA practitioners commonly use these dubious procedures:

  • A supine leg-length check that reveals disparities in leg length when the head is turned left or right.
  • Use of thermography or infrared thermocouple devices to measure skin temperature over the cervical spine.
  • A postural analysis using the “NUCCA Anatometer” that requires standing on a platform apparatus that measures postural imbalance, pelvic distortion, head tilt, and unequal right and left leg weight bearing.
  • Three x-ray views of the atlas-axis area.
  • Use of a protractor to measure atlas alignment.

The patient is then placed in a side-posture position so that the heel of the hand (pisiform bone) or a machine stylus can be used to adjust the “misaligned” atlas.

NUCCA Treatment of High Blood Pressure

The NUCCA approach to treating human ailments received unexpected support recently when a pilot study published in a legitimate medical journal suggested that correcting atlas misalignment would reduce early high blood pressure. A larger clinical study of the effect of upper cervical manipulation on Stage 1 hypertension will soon be done at the Palmer College of Chiropractic under a grant awarded by the National Center for Complementary and Alternative Medicine. “This project will replicate and expand upon a recent study published in the Journal of Human Hypertension, which found that a specific chiropractic technique known as National Upper Cervical Chiropractic Association (NUCCA) is effective in lowering high blood pressure within a small group of hypertensive patients. The study will involve eight weeks of chiropractic care in 155 patients. The clinical site for patient care will be at Palmer’s Davenport Campus.” (Chiropractic Economics, Chiropractic News, May 2008)

Views and Opinions of a Skeptic

I have never been convinced that manual therapy of any kind can produce a permanent reduction in blood pressure. Some forms of manual therapy can temporarily lower blood pressure while others may temporarily raise blood pressure. Tension relief or relaxation that occurs as a result of manual therapy may temporarily lower some forms of high blood pressure, but I don’t know of any way that neck manipulation can permanently reduce high blood pressure, which has many causes unrelated to the neck. Except in cases involving gross anatomical abnormality or injury to the upper cervical area, affecting vascular structures, there is no reason to believe that slight misalignment of the atlas would affect blood pressure, especially the minor, painless “subluxations” routinely adjusted by NUCCA upper cervical chiropractors

When I was in chiropractic school back in the early 1950s, I learned from Best & Taylor’s Physiological Basis of Medical Practice that compression of the carotid sinus at its bifurcation in the upper cervical area would cause a fall in blood pressure and heart rate by raising the pressure in the sinus, while pressure on the common carotid artery in the lower cervical area would raise arterial pressure and heart rate by reducing pressure within the carotid sinus. Such effects resulting from manual stimulation are, of course, temporary, and not a cure for essential hypertension or for high blood pressure caused by bad kidneys, diseased arteries, and other organic problems.

Whatever effect neck manipulation might have on blood pressure, the claim by chiropractic NUCCA “upper cervical specialists” that they can lower blood pressure by correcting minor misalignments of the atlas to relieve “brain stem ischaemia” and to normalize brainstem neural pathways is too implausible to be taken seriously. When the atlas is freely movable and is not locked by painful disease or injury, its resting place, which is determined by the anatomical structure of the articulating surfaces of the occiput, the atlas, and the axis, cannot be changed. NUCCA chiropractors may simply measure structural asymmetry to determine if the atlas is misaligned. Since there are no intervertebral discs and no interlocking joints in the articulation of the atlas with the occiput and the axis, the atlas will move when manipulated, as it does in everyday head movement, but the atlas always returns to its anatomically dictated resting place, as determined by ligamentous constraints and the contours of joint surfaces. Even when there is atlanto-occipital fixation or atlanto-axial fixation, there is no reason to believe that the brain stem would be affected if injury has not occurred and there is no anatomical deformity.

In my 43 years of practice as a chiropractor, I was never able to determine that manipulation of the spine ever permanently changed the position of the atlas or any other vertebra that is freely movable.

The NUCCA chiropractor who examined and treated the patients who participated in the study published in the Journal of Human Hypertension (Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Vol. 21, No. 5, 2007) determined alone that he had located and corrected “atlas misalignment” in otherwise healthy patients who had misalignment as indicated by imbalances detected in a supine leg length check and by other questionable operator-dependent assessments such as measuring pelvic distortion and cervical skin temperature. A “NUCCA Anatometer” was used to measure “postural asymmetries.” The treating chiropractor, who has been using the NUCCA technique for 50 years, provided both sham procedure and real treatment in this “double blind placebo-controlled” study. He believes that the atlas vertebra is the “fuse box to the body,” and that when the atlas is misaligned as little as half a millimeter bad things happen to the body. (WebMD Medical News, March 16, 2007)

Obviously, it would be difficult or impossible for a dedicated non-blinded NUCCA practitioner to provide sham intervention to one group and real treatment to another group without transmitting his belief to the patient, possibly triggering a placebo effect in the treatment group.  X-ray measurements performed by one person might be influenced by patient positioning and by the prejudice of the investigator. An attempt to replicate the findings of such a flawed pilot study with another study done in a chiropractic college using similar procedures would certainly raise questions. Short term treatment for fluctuating blood pressures in patients with Stage 1 hypertension (pressures less than 159/99 mm of Hg, with no known cause) would be difficult to evaluate.  The conclusion that “restoration of Atlas alignment is associated with marked and sustained reductions in BP” after eight weeks of weekly upper neck manipulation begs for another explanation.

Examining claims that chiropractic manipulation can lower blood pressure, a study published in a 2002 issue of Journal of Hypertension (Treatment of Hypertension with Alternative Therapies Study: a randomized clinical trial. Vol. 29, No. 10) concluded that “For patients with high normal blood pressure or Stage 1 hypertension, chiropractic spinal manipulation in conjunction with a dietary modification program offered no advantage in lowering either diastolic or systolic blood pressure compared to diet alone.”

The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant. I would be surprised if a legitimate properly controlled study offered proof that upper neck manipulation would permanently lower blood pressure that has an organic origin. The claim by NUCCA practitioners that a painless slightly misaligned atlas is a cause of high blood pressure does not have enough supporting evidence to warrant the risk of manipulating the necks of patients suffering from high blood pressure, risking injury to vertebrobasilar arteries.

The findings of the questionable and controversial study in the Journal of Human Hypertension, offering support for contentions that correcting a minor atlas misalignment will lower blood pressure, are being extrapolated by NUCCA chiropractors to prove that upper cervical chiropractic is an effective treatment for organic ailments. According to the chiropractor who participated in the blood pressure study, “…high blood pressure is far from the only thing an Atlas misalignment causes.” (WebMD Medical News, March 16, 2007)

Although the NUCCA blood pressure study did note that “The mechanism as to why this improvement in BP occurs is unknown and cannot be determined by this study,” the study itself reads like a chiropractic promotional piece. For example, the study states that “What is clear is that misalignment of the Atlas vertebra can be determined by assessment of the alignment of the pelvic crests,” adding that “…pain was not present in any of the patients randomized in this study.” Such statements may be used by chiropractors to support treatment of a variety of human ailments, based on measurement of common but insignificant vertebral misalignment or on harmless structural deviations from normal.

Posted in: Chiropractic

Leave a Comment (49) ↓

49 thoughts on “The Problem with Chiropractic NUCCA

  1. wasabi says:

    It’s Wii Fit with a dose of woo!

    postural analysis using the “NUCCA Anatometer” that requires standing on a platform apparatus that measures postural imbalance and unequal right and left leg weight bearing.

  2. Joe says:

    Thank you for this. I was also disconcerted by the article reporting “lateral displacement” in terms of “degrees” (an angular measurement) and those measurements were in the sub 1-degree range (seemingly unreliable on xray).

  3. seemstome says:

    Why not wait and see how further studies turn out, before deciding whether or not the treatment can be effective or the theory is plausible?

  4. John Snyder says:

    The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant.

    Or to exist at all?

    @seemtone:

    Why not wait and see how further studies turn out, before deciding whether or not the treatment can be effective or the theory is plausible?

    Perhaps because these aren’t legitamate studies to begin with.
    The fact that the NCCAM would fund such a “study” is indicting evidence in support of its elimination.

  5. Diane Jacobs says:

    John Snyder wrote,

    “@seemtone:

    Why not wait and see how further studies turn out, before deciding whether or not the treatment can be effective or the theory is plausible?

    Perhaps because these aren’t legitamate studies to begin with.
    The fact that the NCCAM would fund such a “study” is indicting evidence in support of its elimination.

    There is also this perennial problem: “Although the NUCCA blood pressure study did note that “The mechanism as to why this improvement in BP occurs is unknown and cannot be determined by this study,” the study itself reads like a chiropractic promotional piece.

    Furthermore, something can be ‘evidence-based’ (apparently effective) but still not ‘science-based’ (with a construct based on plausible science).

  6. seemstome says:

    “something can be ‘evidence-based’ (apparently effective) but still not ’science-based’ (with a construct based on plausible science).”

    No that is not possible. If there is good scientific evidence that a treatment works, then whether or not someone considers the construct “plausible” is irrelevant. Judgements about whether or not a theory is plausible are made in light of current knowledge. The point of science is to expand our knowledge, not to contain and restrict it to what has already been accepted.

  7. nobs says:

    seemstome declares:
    —”No that is not possible. If there is good scientific evidence that a treatment works, then whether or not someone considers the construct “plausible” is irrelevant. Judgements about whether or not a theory is plausible are made in light of current knowledge. The point of science is to expand our knowledge, not to contain and restrict it to what has already been accepted.”—

    This looks to be the ‘ol pseudoskeptic argument of:

    “If it was true, there is no way that science could have missed it!”

    This is a variation of the end of science argument – since science already knows everything, and does not recognize the unconventional phenomenon, it cannot be real. Besides being based on a mere belief – that science has discovered everything there is to know – this argument ignores the nature of human perception. Even scientists tend to see only what they want to see, and that is how phenomena that we find completely obvious today, such as Wegener’s plate tectonics – look how South America fits into Africa! – went unnoticed for a long time, and were violently opposed when they were finally pointed out. As Arthur C. Clarke put it:

    “It is really quite amazing by what margins competent but conservative scientists and engineers can miss the mark, when they start with the preconceived idea that what they are investigating is impossible. When this happens, the most well-informed men become blinded by their prejudices and are unable to see what lies directly ahead of them.”

    True skeptics appreciate that the principal flaw of human perception – seeing what one wants to see – can afflict conventional as well as unconventional scientists. Their opinions are moderated by the humbling realization that today’s scientific orthodoxy began as yesterday’s scientific heresy; as the the December 2002 editorial of Scientific American puts it:

    *****All scientific knowledge is provisional. Everything that science “knows,” even the most mundane facts and long-established theories, is subject to reexamination as new information comes in. *****

  8. seemstome says:

    “today’s scientific orthodoxy began as yesterday’s scientific heresy”

    That’s what I meant. Diane Jacobs said evidence is not enough — we all need scientific plausibility. By that reasoning, scientific evidence can be ignored whenever it doesn’t fit your preconceptions of what is plausible or not.

  9. seemstome says:

    “we all need ” should have been “we also need.”

  10. Scott says:

    The actual point is a more subtle one. Specifically, anything which lacks prior plausibility requires more evidence to justify accepting it. Even more so, anything with a large weight of evidence already against it (such as the myth of chiropractic subluxations) requires an even greater weight of evidence to offset that.

  11. David Gorski says:

    Exactly. I look at it this way. The weight of new evidence supporting a proposition that has a lot of strong evidence arguing against its plausibility should be at least approaching the level of evidence against it before I start to think that maybe it’s time to rethink that proposition and consider it to be plausible.

  12. pmoran says:

    There is also the matter of the type of evidence. RCTs are prone to artifact and susceptible to conscious and unconscious manipulation. They can provide quacks, frauds, and naive enthusiasts with some credibility with the public, but the wider medical community expects direct confirmation of core theory and practice, also.

    For example, can NUCCA experts diagnose subluxations with sufficient accuracy and consistency to form the basis of a medical treatment? If so, can manipulation reliably correct them? Is the presence or absence of subluxation correlated with blood pressure in blinded assessments?

    Also what about risks? I doubt if those dinky little gadgets that some NUCCA practitioners use would cause vertebral artery dissection, but they are also most unlikely to do anything useful.

  13. nwtk2007 says:

    Well I see the bias continues.

    Even with evidence the skeptic’s premise is that “we just don’t see how it could be possible” thus we say the study is flawed and without meaning.

    You speak of the perceptions of the researcher effecting their interpretations of experimental results and findings, but the same holds true of the skeptic, preconceived perceptions against a particular concept can prevent them from accepting or considering the truth.

    With the cervical vertebrae, most particularly C1, in such proximity to such nerve centers as, for example, the nucleus of neuron cell bodies that give rise to the vagus nerve, and the sheer complexity of the neuronal interactions of other nuclear centers in that area, much of which is not understood, one would think that even a skeptic could imagine the possibility of some mechanism by which movement or position of C1 could effect blood pressure, or at the very least, vagus nerve output.

  14. mjranum says:

    “subluxations found”?? Have people actually found subluxations? What the hell is a subluxation, anyway?

    How do chiropractors escape lawsuits for false advertising and deceptive business practices?

  15. nwtk2007 says:

    Doctors find subluxations all the time. They are not bound by the definition of a subluxation as you would appear to be interpreting it. A fixated joint segment is a “subluxation” and can easily be found. NUCCA’s demonstrate misalignments on very carefully taken x-rays.

    Your comment is droll at best.

    As to false advertising and deceptive business practices, then I would suggest that where it is found, then file the law suit or tell the authorities. Not taking action is how anyone anywhere gets away with those sorts of things, in all businesses.

  16. Sam Homola says:

    Few would dispute the possibility that anatomical deformity in the upper cervical area or a painful atlas subluxation caused by injury might have some affect on blood pressure or the brainstem. But the assumption that a minor, painless displacement of the atlas (often a millimeter or less) would affect the brainstem has no supporting evidence. Using a NUCCA “supine leg-length check protocol” to detect such subluxations would be afforded little credibility.

    With no intervertebral discs or interlocking joints to restrict movement of the atlas, the atlas is designed to allow millimeters of movement in many directions to facilitate head movement. Ligaments prevent the atlas from actually subluxating. If a millimeter of atlas displacement affected the brainstem, I suspect that human evolution would have self destructed millions of years ago.

    A Nobel Prize awaits the researchers who can prove that moving a normal atlas half a millimeter or more can cure such diseases as multiple sclerosis, epilepsy, Parkinson’s disease, scoliosis, eye infection, attention deficit disorder, and so on…

    Whatever the explanation might be for a reduction in blood pressure following neck manipulation, it will have to be replicated in properly controlled studies.

  17. Versus says:

    @mjranum
    You can turn chiropractors (or anyone else for that matter) in to the Federal Trade Commission for misleading and deceptive trade practices (e.g., advretising) as I explained in my recent comment to the Quack Clinics post:

    # Versus on 06 Aug 2009 at 6:07 pm
    If you have the time and are so inclined, you can turn a website or other forms of advertising of these false claims in to the Federal Trade Commission. It’s pretty easy to do from their website, http://www.ftc.gov/. If you look at their Industry Guidelines for dietary supplements, it’s quite clear that you can’t make such claims and that you must present a blananced view of the evidence pro and con. The Guidelines also frown on testimonials. Even though they are for the dietary supplement industry they can be applied to anything. http://www.ftc.gov/bcp/edu/pubs/business/adv/bus09.shtm
    The more complaints they get the more likely they are to investigate a particular practice or industry.

    In addition, many states have similar laws, usually enforced by the state’s Attorney General or a consumer protection agency.

  18. pmoran says:

    “Even with evidence the skeptic’s premise is that “we just don’t see how it could be possible” thus we say the study is flawed and without meaning.”

    No one said that. The study is taken on board as a piece of evidence of limited force.

    The proposition that tiny displacements of the atlas vertenbra will affect brain stem function or the progress of any systemic illness remains extremely unlikely to be true, given the ample room that exits at this widening part of the vertebral column, among many other considerations.

    It has been pointed out previously that “chiropractic” effects are not noted to be associated with REAL disturbances of brain stem function — from trauma, vascular damage, or compression by neoplasm, and also not with severe degenerative changes of the spine.

    This is all relevant evidence, too.

  19. Harry says:

    I’ve always thought it was ironic that Chiropractors always mistake, what are clearly Somatic Dysfunction, as Subluxation

    Yuk, Yuk.

    I would like to know more about the similarities and differences between Chiropractic Manipulation and Osteopathic Manipulation. When I sit in my Osteopathic Principles and Practices I struggle to triage the material thrown at me. What line between the methods which have been scientifically vetted and the pure quackery is hazy and hard for my OMS-II mind to find. I just assume throw it all out than risk harming my patient.

  20. cecilia says:

    Dr Homola writes: “Whatever the explanation might be for a reduction in blood pressure following neck manipulation, it will have to be replicated in properly controlled studies.”

    Please comment what, in your opinion, would be a “properly controlled” study. What would this study look like?

    Also I looked at the original study published in the Journal of Human Hypertension. Since I am not a professional MD or DC, I did not understand exactly what they were saying in terms of reduction of blood pressure. Could you rephrase what they said in layperson’s terms? Thank you.

  21. Sam Homola says:

    Altho the NUCCA study was identified as a double blind, placebo-controlled study, the researcher who located the atlas “subluxations” also applied all the treatment in the NUCCA group and all the sham treatment in the placebo group, possibly allowing intrusion of bias or subconscious action that might have influenced the outcome of the study. This is clearly not a true double blind study. Wikipedia has a clear description of a randomized control study. There are others on this list who are more qualified than I am to translate the terminology and the symbols of a scientific study.

    The conclusion that blood pressure was lowered in the NUCCA group is not being questioned. The dubious procedures used and the explanation given for this apparent reduction in blood pressure are being questioned.

  22. Trish says:

    I just had to respond to this. My 57 year old husband has high blood pressure 140/90 – 150/100 range. He does not like doctors and is not being treated by one for his high bp. We have tried everything “natural” – vitamins, herbs, diet. exercise. Nothing changed the numbers. He has neck pain and a lot of headaches. To shorten this, I stumbled across NUCCA while web surfing. He VERY sceptically went for a nucca adjustment yesterday. He took his blood pressure last night …it was 125/76. He was astounded and so am I. Can this be explained? If it’s just positive thinking – he certainly didn’t go in to see the doctor with any thing but intense scepticism.. we’ve just tried to many things that didn’t work.
    So, I know there are a lot of negative comments here about this procedure – I can’t comment on all the science and whether the experiment was prejudiced by the doctor. All I can say is my husbands bp made us both very happy.

  23. Harriet Hall says:

    Trish,

    Yes, this can be explained. I don’t know what the particular explanation is in this case. Some explanations in other cases have included chance, normal fluctuation in the course of disease, some other unrecognized therapeutic effect (something different in diet, lifestyle, etc.), and a psychological relaxation effect after having “done something” intended to help. I have seen my own blood pressure change more than that from one hour to the next for no apparent reason except relaxation: from 170/90 to 99/50!

    Beware of the post hoc ergo propter hoc fallacy.

  24. Chris says:

    Which is exactly why there is this saying (and I am now using the form used by Dr. Crislip in his Quackcasts):

    The plural of anecdote is anecdotes, not data!

  25. OZDigger says:

    Sometimes Harriet, you say the most ridiculous things.

    “Yes, this can be explained. I don’t know what the particular explanation is in this case.”

    Using your analogy and reasoning, any reduction in blood pressure from medication, yoga etc could be due to anything, even serendipity.
    Funny, when you think of all the meds. people are taking for this.
    I thought you were science based. This explanation sounds so much like woo, I can hear the skeptics laughing from their pedestals. Shame on you.

  26. Harriet Hall says:

    Yes, any reduction in BP could be due to anything. That’s why we have to do controlled trials. That’s what science-based means.

  27. nobs says:

    Trish- Thank-you for taking the time to post, recounting your husband’s experience.

    It is highly unlikely that his response to treatment can be dismissed as “chance, normal fluctuation in the course of disease, some other unrecognized therapeutic effect (something different in diet, lifestyle, etc.), and a psychological relaxation effect after having “done something” intended to help.” Albeit, most here will insist on their dismissive, pseudo-skeptical, dogma.

    The NUCCA Blood pressure study was a well constructed study, published in a peer-reviewed, pubmed journal. Larger, follow-up studies are currently being conducted. For anyone one to attach “dubious” to it, is just plain….well… VERY dubious.

    You can read the entire study, published in the medical- ‘Journal of Hypertension’- here: http://www.nucca.org/files/Hypertension2007.pdf

    Please post back here with updates on your husbands’ blood pressure. I look forward to your future posts.

  28. nobs says:

    Chris-
    Sometimes the plural of anecdote can be data.

  29. Diane Jacobs says:

    So fast to try to take credit for lowering blood pressure through mechanical forces applied to necks. So reluctant to accept credit for creating tears in arteries through mechanical forces applied to necks.

  30. Harriet Hall says:

    nobs cited the NUCCA hypertension study. That study was pretty well discredited on this blog at:
    http://www.sciencebasedmedicine.org/?p=606

  31. Chris says:

    nobs, only if the anecdotes are in numbers that are statistically significant. Then they would lead to a real study, such as the ones that connected rubella in pregnancy to severe birth defects. Otherwise, from individuals… they don’t mean much.

  32. nobs says:

    “# Harriet Hallon 10 Sep 2009 at 11:36 pm
    nobs cited the NUCCA hypertension study. That study was pretty well discredited on this blog at:
    http://www.sciencebasedmedicine.org/?p=606

    I read your linked blog and the several poor, opinion-based, dogma-based, ATTEMPTS to “discredit” the study….. but I read nothing evidence/science-based that can legitimately “discredit” this study.

    Fact is—–It is a well designed, well constructed pilot study. To claim otherwise is misleading and just plain….disengenous. The authors clearly acknowledge the limitations of this pilot study, and made no claims otherwise.

    Perhaps some here are so entrenched in their dogma, that they refuse to aknowledge and objectively evaluate the significant and profound findings of this pilot study.

    A pilot study “asks a question” and then determines, based on the findings, if the results warrant further study. The results of this pilot study have indeed determined that: The preliminary data is of sufficient strength to support further investigation. Those studies have been initiated and are ongoing. Stay tuned.

  33. nobs says:

    “# Diane Jacobson 10 Sep 2009 at 10:59 pm
    So fast to try to take credit for lowering blood pressure through mechanical forces applied to necks. So reluctant to accept credit for creating tears in arteries through mechanical forces applied to necks.”

    It appears you are selectively misusing/misplacing “credit” to obfuscate what is more accurately defined as “evidence”.

  34. Harriet Hall says:

    nobs said,

    “I read your linked blog”
    Didn’t you even notice that the link was to this very blog entry? Have you been commenting on a post you hadn’t even read until now?

    The BP study gave “significant” results, but when the prior probability is 1%, Bayesian analysis shows that a p=.05 only means there is a 3% probability that the results are true.

    Steven Goodman and Sander Greenland, “ASSESSING THE UNRELIABILITY OF THE MEDICAL LITERATURE: A RESPONSE TO “WHY MOST PUBLISHED RESEARCH FINDINGS ARE FALSE”"

    Sam Homola has shown that the prior probability of NUCCA affecting anything, much less blood pressure, is very small.

  35. nobs says:

    # Harriet Hallon 11 Sep 2009 at 11:10 am
    nobs said,

    “I read your linked blog”
    Didn’t you even notice that the link was to this very blog entry? Have you been commenting on a post you hadn’t even read until now?

    Yes I did …ahem….”notice” and was fully aware of your self-referencing and this blog site when I made the post.

    In objective, science-based reflection:

    –Self referencing weakens ones argument—ALA Ernst

    –That does not alter any of science-based findings of the study.

    – Why “evidence” here is always linked back to this blog,….as opposed to …..oh let’s just say…..pubmed….or indexed journals……or ……??…..

    Your “evidence” is not “evidence” at all….. Rather an indignant, unsupported…. “Because I said so”.

  36. Harriet Hall says:

    nobs,

    You did not comment on the point I made about significance and prior probability.

  37. Joe says:

    nobs on 11 Sep 2009 at 12:06 pm “oh let’s just say…..pubmed”

    For political (not science) reasons, Pubmed indexes magazines that are not legitimately scientific. Not surprisingly, you cannot tell the difference.

  38. nobs says:

    # Harriet Hallon 11 Sep 2009 at 2:48 pm
    nobs,

    You did not comment on the point I made about significance and prior probability.

    You did not provide a link for your “sound-byte”. In isolation, your “sound-byte” is scientifically meaningless.

  39. nobs says:

    “# Harriet Hallon 11 Sep 2009 at 2:48 pm
    nobs,

    You did not comment on the point I made about significance and prior probability.”

    You provided no link to your “sound-byte”.

    In isolation, it is meaningless and uncommentable.

  40. nobs says:

    Thank-you for the link. However, it does not address specifically the NUCCA study or your ‘significance/probability’ assertions specific to the NUCCA study. Perhaps you can post the link that directly addresses your sound-bytes relative to the NUCCA study.

    Thank-you in advance

  41. nobs says:

    # Harriet Hallon 11 Sep 2009 at 3:56 pm
    nobs,
    Here is the link:
    http://www.bepress.com/jhubiostat/paper135/

    Thank-you for the link to that very nice paper.

    However it does not specifiically address the NUCCA study, critique the NUCCA study or specifiically address or support your soundbytes relative to “significance and prior probability” of the NUCCA study.

    I will assume you posted the wrong link to support your assertions/soundbytes specific to the NUCCA study, ………and the correct link will be forthcoming?

  42. Harriet Hall says:

    I didn’t say that link specifically addressed the NUCCA study. It addressed prior probability and its effect on the meaning of statistical significance. Given the low prior probability of the NUCCA study (Sam’s article explains why it is low), there is a high posterior probability that the results are meaningless.

  43. nobs says:

    That does NOT invalidate the study, or reduce the strength of it’s findings.

    Are your relying on Homola’s article to ascertain your opinion? I cannot find anything in his article to support that assumption. Can you please provide me/point me to the specific information in the body of Homola’s article that would make you(or any skeptical reader) logically conclude: “there is a high posterior probability that the results are meaningless.”

    Even Homola condcedes “that blood pressure was lowered in the NUCCA group” That is certainly not meaningless, even according to your own preferred source.

  44. Harriet Hall says:

    nobs,

    If prior probability is low, a significant finding does not mean the posterior probability is high. The findings in the BP study were significant, but they were most likely not valid. Sam’s whole article supported the concept that NUCCA’s prior probability is low. I’m sorry you were unable to understand my point. The concept is difficult.

  45. nobs says:

    “# Harriet Hallon 12 Sep 2009 at 1:34 pm

    Harriet declares:

    If prior probability is low, a significant finding does not mean the posterior probability is high. The findings in the BP study were significant, but they were most likely not valid. Sam’s whole article supported the concept that NUCCA’s prior probability is low. I’m sorry you were unable to understand my point. The concept is difficult.”

    First of all Harriet——Let’s just for a moment, say… we want to entertain your assertion of—-” prior probability is low”……… FACT IS: the only evidence you have provided to support your assertion of “low prior probablilty” is an editorial on a blog site…….HMMMMMM……Not exactly what would be considered or cited as “evidence” by anyone science-based. I’m sorry you were unable to understand my point. The concept is difficult.

    AND-

    IF- According to you, “prior probability is low”, a significant finding cannot dismiss that the posterior probability can indeed, AND as is in this case,== be high.

    To boil it down: a low prior probability(which Harriet has failed to establish), does not automatically or equivocally confer that the posterior probability is therefore low. The findings of a well constructed study are what they are, which may disappoint those with personal predetermined prejudices.
    I’m sorry you were unable to understand my point, Harriet— The concept is difficult.

    HH- “The findings in the BP study were significant, but they were most likely not valid.

    You have repeatedly failed to provide anything that specifically or scientifically-based, addresses ANY specifics of the BP study that you appear to want to so stocically dismiss as being “not valid”.

    Please provide academic, science-based referenced evidence that is specific to the published BP study being discussed. While this venue is indeed a blog, it would, IMO, be appropriate to cite science-based evidence, as opposed to opinion. I’m sorry you were unable to understand my point. The concept is difficult.

    HH declares:-”Sam’s whole article supported the concept that NUCCA’s prior probability is low.

    Harriet- you appear to be using “concept” to incorrectly imply “evidence”.I’m sorry you were unable to understand my point. The concept is difficult.

    There is nothing in Homola’s “whole article”/editorial, that supports, or links to, or provides indexed evidence, or to what you loosely choose to claim as your ill-defined, ambiguous, “concept”. In science-based studies terms are very specifically defined. You have failed to do so here. I am sorry you are unable to understand my point. The “concept” is difficult.

  46. OZDigger says:

    “Yes, any reduction in BP could be due to anything. That’s why we have to do controlled trials. That’s what science-based means.”

    This statement from Harriet is the essence of her argument, and thus condemns successful all treatment of BP to serendipity. What a waste of money, side-effects and verbiage.

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