when i see the hatred that you spew in spite of evidence to the contrary it makes me feel bad for your level of ignorance. sorry that you suffer this way…
back to fact based conversation…if the criteria that you espouse is applied to the (actually your) gold standard of medicine, a 1995 Duke University study points out that only a minuscule amount of medical interventions are validated scientifically. …Hello pot? kettle calling…
A sad fact, given all the research funding provided by Big Pharma…The chiropractic research world has an tiny portion of the funding that medical research does, yet we turn out way more results on a per capita basis…
when i see the hatred that you spew in spite of evidence to the contrary it makes me feel bad for your level of ignorance. sorry that you suffer this way... back to fact based conversation..if the criteria that you espouse is applied to the (actually your) gold standard of medicine, a 1995 Duke University study points out that only a minuscule amount of medical interventions are validated scientifically. ...Hello pot? kettle calling.... A sad fact, given all the research funding provided by Big Pharma...The chiropractic research world has an tiny portion of the funding that medical research does, yet we turn out way more results on a per capita basis...Why not go the full route and provide some links?
Here is a link to the article(s) about the actual lack of evidence for medical interventions…
http://www.chiro.org/LINKS/FULL/Where_Is_The_Wisdom.shtml
Sidney,
You are the one whose getting all emotional about this debate. No one here “hates” chiropractic or chiropractors, we simply recognize that the evidence indicates the theory is nonsense and the treatment almost entirely useless. It’s completely self-serving an silly to suggest that anyone who disagrees with you is motivated by hate, anger, ignorance, etc. You have provided no evidence in support of your position and have ignored all the evidence against it. That marks you as a defender of a faith-based belief system, not a rational or scientific position. You are entitled to whatever beliefs you choose, but no one else has to take them seriously if you defend them with personal insinuations and only opinion as evidence.
No evidence of efficacy…? i’ve posted 4 studies, all but a small sampling of the fact that chiropractic treatment works…and all in peer reviewed journals…there are plenty of trials published in JMPT, also a peer reviewed journal. so your insinuation that chiropractic has no scientific basis is in fact, erroneous…sorry to point to the facts…Most pharmalogical/medicinal interventions are either poorly understood in terms of how they work, or not understood at all…but i don’t see you up on your soapbox complaining about that…lets call a spade a spade. you have a hate on for Chiropractic. The problem is, it isn’t 1961 anymore. More and more studies are being done to support the use of Chiropractic and in fact expand it’s use among the population, thereby leading to a more drug free natural means of better health for individuals…
No evidence of efficacy...? i've posted 4 studies, all but a small sampling of the fact that chiropractic treatment works...and all in peer reviewed journals...there are plenty of trials published in JMPT, also a peer reviewed journal. so your insinuation that chiropractic has no scientific basis is in fact, erroneous....sorry to point to the facts...Most pharmalogical/medicinal interventions are either poorly understood in terms of how they work, or not understood at all...but i don't see you up on your soapbox complaining about that...lets call a spade a spade. you have a hate on for Chiropractic. The problem is, it isn't 1961 anymore. More and more studies are being done to support the use of Chiropractic and in fact expand it's use among the population, thereby leading to a more drug free natural means of better health for individuals...I can't improve on what Mckenzie has already done here. If you are enamored with chiropractic nothing we say or facts we present are going to change your mind. You are clearly a believer. Perhaps you could explain to me though why you believe that chiropractic treatments are more "natural" (an ill defined and commonly misused word) and why you seem to think anything that is "natural" would be better than standard (?unnatural) treatments. Please keep in mind that much of what we do as physicians does not involve drugs at all and many chiropractors do use drugs of both the traditional type and the misnamed "alternative" (more correctly described as untested and unproven) type, so the dichotomy you imply is in itself incorrect.
Let’s look at the evidence for the claims I made earlier. These are thorough and systematic reviews that take into account the quality of the studies, since poor quality studies can be made to look like they support anything. They are also far more current than the studies you refer to, several of which were done in the 1970s and have been superseded.
- Subluxation theory is bogus:
Mirtz TA, Morgan L, Wyatt LH, Greene L. An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropractic & Osteopathy 2009, 17:13, 2009.
:There is a significant lack of evidence in the literature to fulfill Hill’s criteria of causation as regards chiropractic subluxation. No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability." - Chiro may have minimal beneficial impact on back pain but no proven benefits for anything else.
Ernst E, Carter PH. A systematic review of systematic reviews of spinal manipulation. J R Soc Med 99:192,196, 2006.
“Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment. "
Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008880.
“High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain.”
Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010; 18: 3.
“Spinal manipulation/mobilization is effective in adults for acute, subacute, and chronic low back pain; for migraine and cervicogenic headache; cervicogenic dizziness; and a number of upper and lower extremity joint conditions. Thoracic spinal manipulation/mobilization is effective for acute/subacute neck pain, and, when combined with exercise, cervical spinal/manipulation is effective for acute whiplash-associated disorders and for chronic neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for any type of manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. For children, the evidence is inconclusive regarding the effectiveness of spinal manipulation/mobilization for otitis media and enuresis, but shows it is not effective for infantile colic and for improving lung function in asthma when compared to sham manipulation.
The evidence regarding massage shows that for adults it is an effective treatment option for chronic LBP and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. For children, the evidence is inconclusive for asthma and infantile colic.
Why is it that the results of RCTs often do not confirm the results observed in clinical practice? There are several reasons. One of the problems is that both the provider and the patient are likely to interpret any improvement as being solely a result of the intervention being provided. However this is seldom the case. First, the natural history of the disorder (for example. acute LBP) is expected to partially or completely resolve by itself regardless of treatment. Second, the phenomenon of regression to the mean often accounts for some of the observed improvement in the condition.
Additionally, there is substantial evidence to show that the ritual of the patient practitioner interaction has a therapeutic effect in itself separate from any specific effects of the treatment applied.”
Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educationsl booklet for the treatment of patients with low back pain. NEJM, 339:Vol 15:1021-1029, 1998.
Summary: “For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similareffects and costs, and patients receiving these treatments hadonly marginally better outcomes than those receiving the minimalintervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.”
Given the minimal chance of benefits, the real possibility of harm has to be weighed as well:
Gouveia LO, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine 34(11) E405-13. 2009.
“The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations.”
Rothwell, DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: A Population-based case-control study. Stroke 32:1054, 2001.
Summary: Patients with a vertebrobasilar artery stroke who were under the age of 45 were 5 times as likely as controls to have visited a chiropractor during the week preceding their stroke.
"no evidence that chiropractic works" ok thanks for posting that comment. It confirms my suspicion that you have no merit to what you say.... The Hendryson Report — a military orthopaedic ward study: During WWII Irvin Hendryson, MD, a member of the American Medical Association board of trustees, conducted a clinical comparison study of GIs treated medically. The army provided him with an ideal climate of patient control, and little patient rapport other than discussion of the soldiers' specific ailments. He sent the results of his study to the AMA, which years later were made public. Conclusions: Chiropractic had impressive success with some medical failures, and the chiropractic adjustments were at least as effective as some of the best army treatments available. Therefore, chiropractic care should be an integral part of all medical orthopaedic wards. He also noted that chiropractic had significant success with women in their third trimester of pregnancy, as women were able to carry and deliver their children with more comfort when receiving chiropractic adjustments. Oregon Worker's Compensation Study: A review of worker's compensation records compiled in a study by Rolland A Martin, MD, in 1971 compared the results of chiropractic and medical treatment for patients with comparable back ailments. Conclusions: 82 per cent returned to work within one week under chiropractic care, and 42 per cent returned to work within one week under medical care.Therefore, patients under chiropractic care got well in one-half the time as those under medical care, and suffered only one-half as much. The Silverman AV Med HMO Study: A clinical study was performed using the first 100 patients sent to the Silverman Chiropractic centre by AV Med, the largest medical health maintenance organisation in the south-eastern United States. Conclusions: Prior to chiropractic adjustments, 80 of 100 patients were treated medically, seeing an average of 1.6 medical doctors without results. Seventeen were medically diagnosed with disc problems, and 12 were diagnosed as needing disc surgery. After chiropractic adjustments, 86 per cent had their ailments corrected, none required surgery, and none were made worse. Herbert Davis, MD, medical director of AV Med and author of the study, concluded that chiropractic adjustments saved AV Med US$250,000 in surgical costs. He further admitted that he was originally a sceptic, and the study proved to be an "eye-opening experience" on the effectiveness of chiropractic. State of California Industrial Back Injury Study: In a study conducted by Richard Wolf, MD, in 1972, 1,000 patients were questioned about work time loss and residual pain. Six hundred and twenty-nine responded, with 50 per cent treated medically and 50 per cent receiving chiropractic care. Patient time loss was cut in half with chiropractic care in all three categories, suggesting that chiropractic is very effective for back injuries. sorry to dispel your nonsense comment with the facts...there are plenty of other studies...Every one is entitled to be wrong in their opinion...no one is entitled to be wrong in the facts ...I can find no citation online of the Hendryson Report. Is the Jamaica Observer a recognized scientific peer-reviewed journal? The California back injury study, the Oregon Workers Compensation Study and the Silverman HMO study are all self-reported anecdotal studies with nothing to back them up. There is nothing scientific in any of them. All are basically people claiming that they felt better after chiropractoc manipulation. That one MD made such claims with no investigation of the claims and nothing scientific to to back them up means nothing. When you can find a scientific study that shows exactly how chiropractic works and that it is anything more than massage, let us see the peer-reviewed studies. We will be glad to examine them.
Since chiropractors work on the back, most people think of the chiropractor as a back specialist. But when back-pain victims visit a chiropractic office, they may be given pamphlets suggesting that chiropractic treatment is also beneficial for asthma, infantile colic, ear infection, digestive disturbances, and a host of other organic or visceral problems. There are many good chiropractors who do a good job treating back pain, but few voluntarily limit their treatment to the care of back pain. Chiropractic colleges are still teaching the theory that using spinal adjustments to correct vertebral subluxations will restore and maintain health. Unless you see a chiropractor who has been recommended by an orthopedic specialist or who works with physicians in a back-pain clinic, your chances of finding a properly limited chiropractor are slim. Poorly informed consumers may not know where to draw the line when they visit a chiropractor.
“That spinal manipulation is somewhat effective symptomatic therapy for some patients with acute low back pain is, I believe, no longer in dispute,” said the editorial in the New England Journal of Medicine [10]. But “there appears to be little evidence to support the value of spinal manipulation for non-musculoskeletal conditions. For this reason, I think it is currently inappropriate to consider chiropractic as a broad-based alternative to traditional medical care.”
As for the Rand Study
“A 1996 RAND report on The Appropriateness of Manipulation and Mobilization of the Cervical Spine estimated that stroke and other injuries resulting from cervical spine manipulation occurred about 1.46 times per 1,000,000 manipulations [12]. It also concluded that only 11.1% of reported indications for cervical manipulation could be labeled appropriate. A patient who receives regular, frequent, and totally unnecessary neck manipulation is subjected to greater risk. Since many cases of stroke caused by cervical manipulation have not been recognized as such, studies are being done to determine how many stroke victims had neck manipulation prior to their stroke. The incidence of stroke from cervical manipulation might be much higher than indicated in past studies. A study by the Canadian Stroke Consortium, published in the July 18, 2000, Canadian Medical Association Journal, for example, reported that stroke resulting from neck manipulation occurred in 28% of 74 cases studied [13]. Other causes were sudden neck movement of various types. The most common finding was vertebral artery dissection (splitting or tearing of arterial walls with clot formation and embolism) caused by sudden movement or rotation of the top two cervical vertebrae.”
“Chiropractors commonly manipulate the upper cervical spine as a treatment for head and neck pain. But since such pain in itself can be a symptom of vertebral or carotid artery dissection, especially following injury, it may be wise to forego neck manipulation for sudden onset of head or neck pain until risk factors can be better identified. Informed consent should always be obtained from patients about to undergo cervical manipulation. In many cases, massage, traction, and other forms of therapy can be substituted for prescribed cervical manipulation. Tension headache, for example, is commonly treated with chiropractic neck manipulation. A study published in the Journal of the American Medical Association found that spinal manipulation was no more effective than massage in relieving episodic or recurring tension headache [14]. So be cautious. Until studies on cervical manipulation have been completed, don’t submit to neck manipulation unless you have a problem that cannot be treated any other way. A chronic “cervicogenic” head pain, for example, in which pain is transferred from joints in the cervical spine, can often be relieved with appropriate cervical manipulation. But such manipulation should be done only after a correct diagnosis has been made and other forms of treatment have failed.”
The Bottom Line
“A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you’ll have to exercise caution and informed judgment when seeking chiropractic care.”
to senior member…you may want to look through JMPT, a peer reviewed journal which contains a number of chiropractic research studies…i’ll provide you with a number of studies in other peer reviewed journals…now one other thing to consider…here in canada where the public has the choice of going to one’s MD and being seen for free…or visit a chiropractor …in which case, you will be required to pay for service (unless you have been injured in a MVA or have had a workplace injury, in which place, we are covered). Now if what Chiropractor’s did was as much scientific nonsense as you say it is…then why would people choose to see us? Especially when they can get medical care for free…the answer lies in the fact that what we do provides relief for people and it is a means of getting musculoskeletal problems alleviated drug free…
Look, it bothers me when my colleagues make outlandish claims about things outside our area of expertise. Just as it bothers me when family doctors try and deal with treating back and neck pain in patients which is biomechanical in nature -which is the majority of them. There is virtually nothing medicine can provide for these patients and a good MD will find a Chiropractor in their area to work with. It happens here routinely. I refer out to a number of MD’s and they to me. When they do, I will send back a report of my findings and inform them of my intended treatment plan.
I have no problem when those in the medical community get irate when they see a chiropractor advertising that they can cure asthma or whatever. But to try and discredit the whole profession will just leave you looking like a bitter jaded person with a personal vendetta.
And one other thing. We don’t need an MD telling us what we can and cannot treat or who should be sent to us by referral…save your arrogant patronizing attitude as it doesn’t work in 2016 anymore. People have many choices for healthcare. And, Chiropractors are portal of entry physicians which means patients don’t need a referral to see us.
As I said previously, i’ll provide some more research data shortly.
Let’s have a healthy discussion without the hyperbole folks…
Hey Sidney you’re arguing with a bunch of parrots and narrow-minded industry automatons.
I don’t have a stake in this debate, although I’ve argued it here before.
I have never been to a chiropractor although I definitely have had back and sciatica pain in the past. Not anymore though.(I started working smarter, not harder.)
The points you raise above about the Canada system, the reports you cited etc are all good enough for me.
I am a truck driver and a number of my colleagues have extolled the benefits of chiropractory. Even though I was somewhat skeptical, I knew these guys
weren’t making up their relief and experiences.
I would normally be skeptical for any medical help…traditional or otherwise. That’s just me. I tend to suffer things out and heal. So that’s my skepticism.
Again, you’re literally arguing with a bunch of people who are chomping at the bit here to showcase their boilerplate resistance to anything that isn’t “Traditional”.
I’ve debated the “meta” side to this issue with these folks here for years. They’re robots. At least one is intimately involved with the promotion of militant like promotion of corporate,
establishment medicine.
that is a good point. i don’t mind discussion around the topic of chiropractic care. We are stuck inside most of the time up here on the frozen tundra and tend to take more time in the winter to discuss these things in these types of forums…
stay safe on the road…!
that is a good point. i don't mind discussion around the topic of chiropractic care. We are stuck inside most of the time up here on the frozen tundra and tend to take more time in the winter to discuss these things in these types of forums... stay safe on the road...!Yeah, it would have been nice for you to have a decent discussion..instead you were assaulted. Typical. You even sifted out the garbage pertaining to the original topic...Maximized Living or whatever the hell that is. Where are you in Canada?
As usual, VYAZMA, you having nothing useful or of substance to say, just silly personal attacks on those you don’t like about a subject you admit to knowing nothing about. How is it an “assault” to highlight the scientific evidence sidney1 is wrong? How is it not an “assault” to call people robots and say nothing about the actual topic of debate? Just stirring the pot for the fun of it even when you have no stake in the debate and no knowledge or information on the subject. Not very productive or helpful.
No McKenzie I was actually trying to get someone new to stick around and possibly branch out into other topics.
But you can relax, the 7-9 person echo-chamber is intact.
You and I exchanged insults just now in this thread. Your insults had zero impact on me.
It was exactly what I expected. Literally.
Truth hurts.
manitoba…yeah…not sure how this conversation denigrated from a discussion about maximized living to a general attack on chiropractic…but no worries. I enjoy speaking about chiropractic care…
manitoba...yeah...not sure how this conversation denigrated from a discussion about maximized living to a general attack on chiropractic...but no worries. I enjoy speaking about chiropractic care....Cool. I spent some time in Saskatchewan. I know that's not Manitoba. Sid, I explained exactly why the conversation de-generated into a general attack on chiropractory. They have good points to make. Don't get me wrong. But I think you do to. That could have developed into a decent discussion or polite debate...instead you were ostracized in one minute. Stick around anyways. There's other topics. Who knows?
mckenzie…
Here are a few studies for you to no doubt find fault with which point to efficacy of chiropractic…and before you get on your soapbox about an explanation of how chiropractic actually works, consider that the vast majority of medical interventions are either poorly understood or not understood at all. so which standard are you measuring chiropractic by? because if its’ the one set by modern medicine then either you are a hypocrite or just blind to the truth about the “gold” standard that medicine sets…
Spine (Phila Pa 1976) 2003 (Jul 15); 28 (14): 1490–1502
J Manipulative Physiol Ther 2005 (Jan); 28 (1): 3–11
http://www.chiro.org/LINKS/ABSTRACTS/Adding_Chiropractic_Manipulative_Therapy.shtml
BMC Musculoskelet Disord. 2012 (Aug 28); 13: 162 ~
sidney1,
Yes, you will be able to find studies that suggest chiro works for back pain. I will be able to find studies that show it does not. The best evidence, which is systematic review-level evaluation of all such studies that takes risk of bias into account, is the Cochrane review I’ve already cited, which shows that overall the literature supports only minimal benefit from chiro for lower back pain, comparable with massage or rest. This is how medical science works, and the problem with it, of course, is that anyone who doesn’t like the conclusion is free to ignore it and claim the treatment works no matter what the research says. Things a lot less reasonable than chrio, like homeopathy, reiki, and prayer, all have studies which their proponents claim show they work. Do you believe everything if there are any positive studies? If not, how do you decide which to believe and which not to believe? Personal experience? Plausible theoretical mechanism? How do you make these decisions?
As for the mechanism, that is a somewhat separate issue from whether or not the therapy works, which is why I listed them separately. It is clear that there is no established mechanism to explain chiro, since the VSC is a fiction. That doesn’t mean chiro doesn’t work, and if there were robust clinical trial evidence showing it did, then we could decide that without having a mechanism. This is true for some well-established therapies, though nothing like the “vast majority” as you claim. However, the absence of a mechanism IS a weakness of claims for chiro, and combined with the balance of the clinical trial literature being against it, I think it is unlikely to be much more than an expensive massage with a lot of, as even you admit, nonsense attached to it (such as the large number of DCs who oppose vaccination, for example, or the subset who recommend colon cleansing, herbs, and all sorts of other quackery).
Bottom line is if people want to see a DC, that’s their business, If they care what science says, they will find that there’s little reason to think it will help them, but not everyone care what science has to say.
VYAMA,
Huh? What truth hurts whom? And what the hell is the “7-9 person echo chamber?” Your posts just get stranger and stranger.
I’m actually having a discussion with the OP writer, so I don’t know how you think my posts are shutting that down.
It seems to me that your comments here represent the deep and time-honored strain of anti-intellectualism in American culture. You have an opinion on the subject even where you have no information, and you dislike it people who have spent years of their lives studying and practicing medical science try to point out why your opinion is wrong. Being simultaneously opinionated and ignorant is somehow seen as a virtue, and being a professional trying to argue the case using scientific evidence somehow makes me and MacGyver “The Establishment” or some kind of elitist bogeyman. Everyone is entitled to an opinion, of course. And if you can back that opinion up with evidence, then it deserves just as serious consideration as the opinion of scientists, doctors, and anyone else. But that’s not at all what you do in these discussions. You just share your beliefs and then insult anyone who doesn’t accept them.