[Andrew Stephens]

the quackometer: McTimoney Chiropractors told to take down their web sites

[Laminar]

Summary? Was this a prank letter sent to a chiropractor?

[ghporter]

No, apparently there are chiropracters in the UK that are claiming to fix stuff that bone manipulation isn't shown by research and evidence to impact.

There ARE legitimate chiros around. They make no claim that their actions will help the common cold, reduce ulcers, or cure colic. But others go way beyond adjusting and aligning the spine (which in itself is an excellent method of helping people whose vertebrae are out of alignment from accident or muscle use imbalance), or beyond the physical limitations of what the evidence says that spinal alignment can do.

[shifuimam]

Indeed - if you look into the origins of chiropractic, it's based on the belief that adjusting the spine can adjust the "fluids" running through the body, thereby treating, healing, and curing maladies completely unrelated to the spine.

[Andrew Stephens]

Originally Posted by Laminar 

Summary? Was this a prank letter sent to a chiropractor?

Background.
Guardian newspaper science writer Simon Singh wrote in an article that UK:
"“The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”"

The BCA sued for libel and a UK judge decided that, although later in the article Singh explicitly stated that the BCA was doing this unknowingly (why?) the term "bogus" implied it knew it was spouting quackery.

Now, in order to win his lawsuit Singh has to effectively prove that the BCA knew it was promoting treatment without evidence. An impossible task.

Singh stands to loose hundreds of thousands of pounds if found guilty.



http://www.simonsingh.net/

[ghporter]

I'd say that the email in your link was pretty damning of the BCA-or at least the practice association that sent it. Using ANY "therapeutic" procedure that isn't backed up by solid evidence is tough-and more so in some professions where getting the needed experimental data is very difficult due to the ethical issues involved in the experimental process. How do you NOT provide a therapeutic intervention to someone so they can be part of a control group when you know it works, even though you don't have solid evidence to back it up? On the other hand, modern chiropractic IS able to back up lots of what they do-as long as it's directly musculoskeletal-related. It's the dodgy "colic and ear ache" issues that get them in trouble.

[- - e r i k - -]

Ouch.

But about time. "Chiropractors" need to clean up their act. They are not based on legitimate science and would be better off practising as remedial masseurs.

[Railroader]

I have always been skeptical of chiropractors. Seemed like a bit of quackery.

Then, my brother in-law's 4 year old daughter had a horrible time sleeping. She'd fight sleep for hours and when she did fall asleep she'd have severe night terrors within minutes. My brother in-law is a doctoral clinical psychologist and served a fellowship at Dartmouth. His wife is a special educational specialist with a doctorate in psychology. They took her to dozens of specialists and could not find relief. A chiropractor's wife overheard them in a supermarket talking with friends about the problem and said her husband would treat the girl for free. They ignored the offer for a few months but finally were at the end of all non-surgical treatments so the went to the chiropractor.

The first visit was successful.

I have still never been to a chiropractor, and I am still slightly skeptical of their claims, but they helped my little niece and for that I am eternally thankful.

[mattyb]

Completely off topic : Singh's book on Fermat's Last Theorem is really good.

[Kerrigan]

Not to be, like, a dick, but I think this thread needs a better title.

[olePigeon]

Originally Posted by ghporter 

There ARE legitimate chiros around.

No there aren't.

[olePigeon]

Originally Posted by Railroader 

I have still never been to a chiropractor, and I am still slightly skeptical of their claims, but they helped my little niece and for that I am eternally thankful.

Placebos can be a form of treatment in itself.

[lexapro]

I have a friend who went to chiro school and tried for 10 years to be successful. He is now working on an Associate Degree in radiology technology to become an X-ray, CT, MRI and ultrasound tech. No joke.

He told me that chiros are so business oriented that it's impossible for him to function as a practitioner and as a business man and remain successful.

[olePigeon]

Might as well move this to the PWL cuz I'm gonna fight this tooth and nail. I can't stand Chiropractors, they're up there with Intelligent Design proponents on my list of people who need to reformatted.

[ghporter]

What is it about chiro that riles you up so much, olePigeon?

[Railroader]

Originally Posted by olePigeon 

Placebos can be a form of treatment in itself.

Does that belief make you feel better. Perhaps you are proving your own statement true.

Now that I think about it, both parents are also very strict evangelical 7th Day Adventists. Perhaps prayer is truly what cured my niece.

[Shaddim]

I went to a chiropractor for a while, and after the "adjustments" my back felt wonderful, but the problems returned in less than a week. So I kept going back, over and over and over again. He kept telling me that eventually everything would be fine, but it never was. For me it was just a quick fix with no lasting cure.

Perhaps they can help some people, but I wasn't one of them.

[ShortcutToMoncton]

Physio.

Please, people. Just go to a physiotherapist. Please.

greg

[Shaddim]

Acupuncture finally fixed my problems, I go once a month to relax.

[ShortcutToMoncton]

*headdesk*

[- - e r i k - -]

Well, acupuncture has been proven to have at least some results over placebo. It just doesn't matter where you put the needles (the new age meridian mumbo jumbo that it's based on). But yes, go see a physiotherapist.

[Shaddim]

keep hitting it, maybe it'll help.

[Laminar]

Hypnosis worked for me.
Let's just pile it on.

[Phileas]

Originally Posted by - - e r i k - - 

(the new age meridian mumbo jumbo that it's based on)

That's not what acupuncture is based on at all.

[Andrew Stephens]

Originally Posted by Phileas 

That's not what acupuncture is based on at all.

Acupuncture is based on non scientific, non evidence based chinese traditional medicine.

Every clinical trial of acupuncture has proved that the only effects in action are placebo effects. It doesn't matter where you place the needles, or even if you don't actually use needles. It's the theatre and ritual that has the effect.

Railroader: your experience is probably what doctors call the "take an asprin and come back in two weeks if its not better", in that most ailments will cure themselves naturally after time. People tend to seek medical help after a period of suffering which means that any attention they get is statistically likely to be at the point of natural recovery. People who get no benefit either have a condition that will not spontaneously recover or are part of the stats the other way.

All non quackery chiro is physiotherapy pure and simple. The other stuff is bogus nonsense.

[Andrew Stephens]

A good book to read is Bad Science by Ben Goldacre. It covers, chiro, MMR, placebo, apalling science journalism and much other stuff.

Bad Science

Bad Science: Ben Goldacre: Amazon.co.uk: Books

[Phileas]

Originally Posted by Andrew Stephens 

Every clinical trial of acupuncture has proved that the only effects in action are placebo effects. It doesn't matter where you place the needles, or even if you don't actually use needles.

That is not correct. Results are contradictory, with no conclusive results. Some trials claim a positive effect, some don't.

[ShortcutToMoncton]

Originally Posted by Phileas 

That is not correct. Results are contradictory, with no conclusive results. Some trials claim a positive effect, some don't.

Sounds... like placebo to me.

greg

[mattyb]

Originally Posted by ShortcutToMoncton 

Sounds... like placebo to me.

They got a new drummer. I like their latest stuff.

[ghporter]

Originally Posted by ShortcutToMoncton 

Sounds... like placebo to me.

greg

Before making that conclusion, you would have to examine all the studies and determine whether or not the experimental procedure was both adequate and properly followed. LOTS of health care research runs into this conundrum. Getting experimental subject volunteers in itself changes the character of your sample. Typically such volunteers are notably more "involved" in a clinical sense than typical patients.

One enormous problem with this sort of research, whether you're talking about physical therapy, occupational therapy, chiropractic or any other non-medical discipline is that unless you ONLY look at the biomechanical problems and interventions, there really is no way to directly connect an intervention with a problem. There's no test for "pain," for example; it's entirely subjective and can change from moment to moment without any observable change in the environment or the patient's condition. Since pain is almost always what sends people to a doctor for treatment (and thus gets them referred to a PT or OT), research is inherently limited in what it can and can't examine.

[Phileas]

Thanks Glen - I didn't want to get too involved with the discussion because I don't want to spend my day in a he said/she said conversation.

The truth is that acupuncture has worked, and is working, for many individuals.
Research on why and how it works or not works is inconclusive.
But just because the research - currently - can't seem to figure out how it does or doesn't work does not mean that we should write it off.

[OreoCookie]

Originally Posted by olePigeon 

No there aren't.

Oh yes, there are: the patients feel better. There are just no medical consequences.

Originally Posted by ghporter 

One enormous problem with this sort of research, whether you're talking about physical therapy, occupational therapy, chiropractic or any other non-medical discipline is that unless you ONLY look at the biomechanical problems and interventions, there really is no way to directly connect an intervention with a problem.

No, there are measurable effects of the others and there is a physical cause (physio) or an improvement (because you learn how to dress yourself with one arm after a stroke).

The service of a chiropractic is nothing more than what you get at a spa: it makes you feel better (ideally). This, of course, is a good thing and can certainly have a positive influence on your health. But acupuncture and all the others won't help fight an underlying medical problem (if there is one). To advertise it cures `medical condition abc' is problematic.

Originally Posted by ghporter 

Since pain is almost always what sends people to a doctor for treatment (and thus gets them referred to a PT or OT), research is inherently limited in what it can and can't examine.

You're half right, but (I think) for the wrong reasons: certainly, you can scientifically prove or disprove whether alternative medicine has any positive effects on medical conditions. For instance, there have been studies comparing `proper' acupuncture with `fake' acupuncture (where the important points were missed on purpose). There was no significant difference in the medical effect.

However, it is difficult to design tests to ensure that the placebo effect (which can be surprisingly strong) is factored out of the equation. There have been tests on people who had to take morphine to alleviate pain: it was found out that the placebo effect replaces a sizeable dose of morphine, just the fact that they were believing they were actually taking care of their medical problems seems to help.

[ghporter]

The objective measure of function is not something that one can directly relate to specific interventions. "Learning" to use an impacted upper extremity after a stroke is a LEARNING process, and thus filled with UNmeasurable details.

The real bugger of the whole research thing is that physicians CAN do straightforward, double-blind tests; some patients get the chemicals that make up the intervention and others get an identical quantity of something else. And because of that, the often "multiple levels of abstraction" research that physical and occupational therapists do is discounted by many physicians, to the detriment of patients.

I repeat, there is a dearth of objective, directly measurable tests for most physical (as opposed to "medical" maladies. I cannot, for example, run a test to find out exactly what parts of Mr. Jones' brain were impacted by how much by his anterior cerebral artery infarct. While certain brain structures will be obviously damaged by the infarct, the surrounding structures may have also been damaged to a lesser extent. Cell death is easy to demonstrate, but synapse damage is unprovable because there's no way to produce a "before" to compare the "after" to. Unless you're talking about a biomechanical injury (torn ligament, dislocation, fracture), a physical or occupational therapist is left with abstractions and inferences from which to evaluate and treat a patient.

[OreoCookie]

Glenn, I think you misunderstood. I merely wanted to say that PTs, OTs and other professionals have nothing in common with people who practice `alternative' medicine.

In my case, thanks to my PT, I can use my shoulder again after it had been broken. She has kept my tendons and such mobile (I wasn't able and allowed to use my own strength to move my arm). Mobility of body parts and in case of OTs the ability to become more independent are things you can measure.

I wouldn't want to mix up your profession with people who'd be better off working in a spa.

[olePigeon]

Originally Posted by ghporter 

What is it about chiro that riles you up so much, olePigeon?

Well,

• Pretending to be medical doctors
• Posing as a board certified medical practice
• Turning people away from proven medicine that works
• Convincing people to not vaccinate their children
• Injuring (sometimes severely) and in rare cases killing people with no liability
• Refusing to inform customers of proven risks associated with chiropractic

You can't sue them for medical malpractice because they're alternative medicine. If someone suffers or even dies from a stroke induced by one of those quacks, they can't be sued.

It's like a religion. People want to believe it works. For many people it works in the same sense as a placebo. For many people they do feel better; like I said, placebo can be a treatment in itself. However, to continue promoting chiropractic as a real treatment to physical and mental diseases or disabilities is disingenuous at best, flat out criminal and sadistic at worst.

I get so riled up because the corporations that govern chiropractic are doing a very good job at convincing the general public that they're a legitimate medical practice when the very philosophy behind chiropractic is at complete odd with that of medical science. A lot of people are missing out on proper health care because they get suckered in by chiropractors that flat out lie to them, making false promises.

[ghporter]

Originally Posted by OreoCookie 

Glenn, I think you misunderstood. I merely wanted to say that PTs, OTs and other professionals have nothing in common with people who practice `alternative' medicine.

Whether I'm able to (in my personal case) use my shoulder after it had been broken can certainly be attributed to my PT who has kept my tendons and such mobile (I wasn't able and allowed to use my own strength to move my arm). Mobility of body parts and in case of OTs the ability to become more independent are things you can measure.

I wouldn't want to mix up your profession with people who'd be better off working in a spa.

I very much did misunderstand you. I'm sort of sensitive about the "I'm a doctor and your research is rubbish" crap that "doctors" (as opposed to "physicians") sometimes throw around, so I tend to get defensive about that research.

However, I'd also point out that your PT was using a biomechanical approach (most of PT is biomechanical) and much of what I did in my adult practice internship was also biomechanical-it's what most people think of when they think of phisical therapy. But there's so much more in OT (and also quite a bit in PT) that is not strictly biomechanical, and this is where research is a problem. How do you quantify whether or not an intervention has the appropriate impact on a child with autism? How do you identify the mechanism through which an intervention improves the quality of life of a patient with early-stage Alzheimer's Disease? Why do sensory interventions work? Getting a doctor to refer people with non-biomechanical issues can be a royal pain because we don't have the same kind of "this drug does X, thus it will do X for all patients" research medicine has (in spite of the fact that their research is biased toward young-to middle-aged white men - based on who most test subjects are). So yeah, I misunderstood.

[ghporter]

Originally Posted by olePigeon 

Well,

• Pretending to be medical doctors
• Posing as a board certified medical practice
• Turning people away from proven medicine that works
• Convincing people to not vaccinate their children
• Injuring (sometimes severely) and in rare cases killing people with no liability
• Refusing to inform customers of proven risks associated with chiropractic

You can't sue them for medical malpractice because they're alternative medicine. If someone suffers or even dies from a stroke induced by one of those quacks, they can't be sued.

It's like a religion. People want to believe it works. For many people it works in the same sense as a placebo. For many people they do feel better; like I said, placebo can be a treatment in itself. However, to continue promoting chiropractic as a real treatment to physical and mental diseases or disabilities is disingenuous at best, flat out criminal and sadistic at worst.

I get so riled up because the corporations that govern chiropractic are doing a very good job at convincing the general public that they're a legitimate medical practice when the very philosophy behind chiropractic is at complete odd with that of medical science. A lot of people are missing out on proper health care because they get suckered in by chiropractors that flat out lie to them, making false promises.

I get a bit miffed that they give themselves the title "doctor" when their educational requirements don't fit anyone else's requirements for that level of education. You can go to chiro schools' sites and their organizations and see all sorts of glowing stuff about how they get MORE anatomy than MDs, etc., but I have not seen any such schools that would accept credits from an accredited medical school... So why not?

Anyway, there do seem to be some legitimate chiropractors around. The Department of Defense recognizes them as a useful discipline and accredits some to provide therapy to military beneficiaries. Certainly not all chiros qualify, but some do; in my adult practice internship, I worked in a military hospital that had a chiropractor on contract, and my mentor highly recommended him-for certain types of therapies.

But obviously such chiropractors would be constrained to NOT do most of what you mentioned in your list, and the ones I've had contact with were not at all like what you say. Of course that's a limited group...

[olePigeon]

Originally Posted by ghporter 

I get a bit miffed that they give themselves the title "doctor" when their educational requirements don't fit anyone else's requirements for that level of education. You can go to chiro schools' sites and their organizations and see all sorts of glowing stuff about how they get MORE anatomy than MDs, etc., but I have not seen any such schools that would accept credits from an accredited medical school... So why not?

They just flat out lie on their websites. This is the same group that says there are zero risks to hyperextending your cervical vertebrate. The same group that is against vaccination of children.

They may know the names of bones, muscle tissue, or major blood vessels, but they are completely ignorant in their function and purpose; basically anything that makes that knowledge applicable to human health.

Originally Posted by ghporter 

Anyway, there do seem to be some legitimate chiropractors around.

There are chiropractors that mix western medicine in with their practice to make them sound legitimate. The Chiropractic board encourages chiropractors to gain knowledge in other areas of standard medicine not because it's the right thing to do, but to promote a better self image; to make them look more legitimate.

They also highly encourage people to take up practice in regions that don't regulate chiropractic. It also only takes 4 years to become a "doctor," with only 1 year of professional experience.

Originally Posted by ghporter 

The Department of Defense recognizes them as a useful discipline and accredits some to provide therapy to military beneficiaries.

You can thank George W. Bush for that one. You can also sign up for: acupuncture, cupping, blood letting, magnetic therapy, and faith healing. They (Republicans and Democrats) passed a law that extended the definition of a Primary Care physician to include alternative medicine.

Originally Posted by ghporter 

But obviously such chiropractors would be constrained to NOT do most of what you mentioned in your list, and the ones I've had contact with were not at all like what you say.

Salesmen tell you what you want to hear.