Is Chiropractic X-raying Illegal?

Chiropractors have achieved a status amongst practitioners of alternative medicine that is almost unrivalled. In the UK, they have achieved a level of mainstream acceptance, regulation and recognition that must be the envy of homeopaths and herbalists. Such is their standing that I suspect that many people would not even consider them as part of the alternative medicine scene. Chiropractors, like their close cousins the Osteopaths, are statutorily regulated in the UK, and this means that they have ‘protected title’ and other rights not afforded to lesser practices.

And yet, chiropractic remains firmly an alternative medicine. It is founded on pre-scientific views of the body (innate intelligence flows though our nerves), a discredited model of illness (subluxations) and a feeble evidence base. Chiropractors are taught that “The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.” Subluxations are suppose to block the flow of ‘innate intelligence‘ around the body. This is a mystical notion with no basis in science.

Whether or not Chiropractors believe this nonsense, taught to them under the watchful eyes of British Universities, we would be quite right to ask if Chiropractic techniques actually help people, regardless of whether the theory behind it is fantasy. Looking at the most recent review of all the evidence (Ernst and Canter, 2006), the conclusion is that “reviews were largely negative, except for back pain where spinal manipulation was considered superior to sham manipulation but not better than conventional treatments. 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.”

At best, Chiropractic looks like one more quack placebo treatment. It may help a little with lower back pain, but that is it – and probably not better than a couple of paracetamol and some moderate exercise. But chiropractors do not let science get in their way. Simon Singh, the award winning science writer, is currently being sued by the British Chiropractic Association, for daring to write in the Guardian that Chiropractors were promoting ‘bogus treatments’ when they suggest that they can cure ear infections and infant colic. Given this, it is even more remarkable that the government has conferred such legislative privilege upon the trade.

One privilege that Chiropractors have is that they fall into one of the few named professions that is legally allowed to refer patients for an X-ray. What is even more remarkable is that Chiropractors, almost uniquely, can fulfil all duties (employer, practitioner, referrer and operator) defined by law when giving medical exposures. (Dentists may do too, but the exposures involved are a lot smaller.)

Now, a basic tenet of ionising radiation protection for many years has been that all exposures should be as low as is reasonably practicable (ALARP). In the medical world, if you are to expose patients to ionising radiation, there must be some clinical benefit from that exposure that justifies the risks. The Chiropractic guidance is clear:

The principle of justification is that medical exposures shall show sufficient benefit so that the potential diagnostic and therapeutic benefit is greater than the individual detriment that the exposure might cause. The key requirement of this section is that each individual medical exposure should be justified in advance.

The UK Ionising Radiation (Medical Exposures) Regulations, IR(ME)R 2000, require that types of practice are justified and that it is “justified by its economic, social or other benefits in relation to the health detriment it may cause.” Presumable Chiropractic has been seen to fit the bill. In addition to the type of practice, the individual exposure must be justified too. This is where I struggle to see how a Chiropractor could make a sound case for ever X-raying a customer.

There are two aspects to this:

1) On what diagnostic basis will the resultant X-ray images be used?

2) How will the subsequent diagnosis inform an effective treatment plan?

Given that Chiropractic is founded on pseudoscientific notions of health and that the concept of spinal subluxations has never been empirically validated, just what are Chiropractors looking for in X-rays? And since chiropractic treatment cannot demonstrate efficacy to a reasonable standard, how will X-raying a patient lead to a therapeutic benefit? In addition, since the positive effects seen for some sort of back pain are only comparable to conventional treatment where no X-ray is required, surely there is always an alternative treatment plan that does not involve exposing the patient to the risk of ionising radiation?

Are Chiropractors misusing X-rays? The trade has come under a lot of criticism for some of its business practices. Do patients really benefit from X-rays at the Chiropractic clinic? Or are they a way of scaring patients into lengthy and ineffective treatment plans?

The Chiropractic profession is regulated in the UK by the General Chiropractic Council. There are times when the X-raying practices of their members has moved them to take action. They note in their 2007 Fitness to Practice Report that,

The Professional Conduct Committee has seen that treatment plans are exploitative when they are constructed around a diagnosis that leads patients to believe they are more seriously ill than they are, with the intention to promote undue dependence on chiropractic care. Some treatment plans, as shown by the evidence heard by the Professional Conduct Committee, were formulated without any adequate assessment or reassessment of patients’ needs. Going hand in hand with this approach was the routine X-ray of patients without justification. The images were used as sales tools further to pressurise patients to accept treatment.

They speak of a few cases:

This year the Professional Conduct Committee heard evidence in one case that also demonstrated a blatant disregard for patients’ safety and wellbeing. Amongst other things, patients, including a child, were exposed to ionising radiation for no other reason than to use X-rays to pressurise patients to sign up to long contracts of care. The individual concerned showed no insight, understanding or remorse for what he had done and was removed from the Register.

During another Professional Conduct Committee hearing, a respondent chiropractor admitted that he had routinely X-rayed nine out of 10 adult patients. Upon considering an audit of nine patient records, the Professional Conduct Committee was of the view that there was no justification for those patients to have been exposed to ionising radiation.

Given that it is difficult to see how any Chiropractic X-ray can be justified, is this just the tip of the iceberg? How widespread is X-raying in Chiropractic clinics and how often are X-rays used? Fortunately, we can look to GCC surveys to answer that question.

In 2004, their members were asked about their X-ray usage.

Table 33. & 34. X-rays

Chiropractors were asked:

a) For what percentage of your patients is an x-ray justified?
b) Do you take x-rays of your patients?
c) Do you refer patients direct for imaging?
d) Do you refer patients for imaging via GPs?
e) Do you interpret the x-rays?

Table 33. a) X-ray justified?
Number of Range chiropractors

0% 9 1%
1-20% 525 61%
21-40% 99 12%
41-60% 51 6%
61-80% 47 6%
81-100% 34 4%
Didn’t specify 89 10%

Table 34. b, c, d, e) X-rays

B C D E
Yes 294 (34.43%) 499 (58.43%) 568 (66.51%) 593 (69.44%)
No 542 (63.47%) 306 (35.83%) 246 (28.81%) 241 (28.22%)
Didn’t specify 18 (2.1%) 49 (5.74%) 40 (4.68%) 20 (2.34%)

Clearly, the majority of Chiropractors are X-raying fairly regularly and some are performing it routinely. There are undoubtedly practitioners out there that believe wholeheartedly in the concepts of subluxations and use X-rays to try to find their mysterious problems. One comment in the Survey noted this ‘fundamentalist’ approach to their art,

A point raised by 6 respondents and made more loosely by several others was that chiropractic is at odds with medicine (basic approach to health) and being closely linked with the NHS will cause the profession to become mere spinal technicians. It was also said that the general population is moving away from the allopathic model of healthcare towards a more vitalistic and holistic model focussed on the pursuit of true health and wellness and in their opinion the chiropractic profession was best placed to lead this ‘wellness revolution’. It was therefore felt that it was in this direction that the GCC should focus its attention to avoid being just another drugless management of back pain.

Why do we not see more prosecutions? That is a tricky question to answer. At the root of the problem is understanding who actually would initiate an investigation and see through prosecutions. When we look at other X-raying healthcare providers we would see the Healthcare Professions Council who might oversee X-ray usage. Chiropractors are special cases and sit outside this regime of regulation and sit under their own regulator, the GCC. It could be argued that this creates a conflict of interest in that serious investigations into widespread misuse of X-rays within Chiropractic could serious damage the reputation of the profession and the businesses of their members.

Ionising Radiation Regulation is complex and it is unlikely that any other authority could step in to address the question. Trading Standards do not have the specialists. The Health and Safety Executive may well be more geared up to ensure the more industrial side of radiation protection is enforced, such as the compliance with controlled areas for exposure. The situation gets even worse when you look at the significant number of ‘spinal manipulators’ who have chosen not to be regulated by not calling themselves Chiropractors. Osteomyologists, according to the Times, are sometimes “illegal chiropractors” and some still carry out X-ray procedures to help with their sales patter. There appear to be no agencies that can be expected to oversee the illegal use of X-rays in this situation.

What should a potential patient do? Well, first of all – do not go to Chiropractors. It is unlikely you will get meaningful benefit from the visits and a few people will get hurt by them. Your back is liekly to get better anyway, and your doctor may be able to advise you on exercise and pain killers. If you do go, walk away if you are offered X-rays and find a chiropractor who believes they do not need to X-ray you. They may well be a little more reliable.

References

Chiropractor’s Use of X-rays E Ernst The British Journal of Radiology, 71 (1998), 249-251

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Note: Due to a technical error when this blog was moved from one platform to another, the comments were not properly imported. What follows is a text archive of the discussion. Please feel free to add to the discussion in the normal way.

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48 Comments:

Anonymous Gazzer said…
I wish the readers of this blog (or perhaps) even the writer himself would try to add some balance to the Wikipedia chiropractic article. (Forget the ‘Wikipedia is crap’ argument – there are a lot of outstanding articles on Wikipedia and it’s where a lot of people go to get their information).

The chiropractic article is close to being good but it needs a few more of the sceptics fighting their side of the argument. So you can see papers that seem to be perhaps written by chiropractors themselves getting too much weight.

29 January, 2009 10:11
Anonymous Blue Wode said…
Quote:
“Given that Chiropractic is founded on pseudoscientific notions of health and that the concept of spinal subluxations has never been empirically validated, just what are Chiropractors looking for in X-rays? And since chiropractic treatment cannot demonstrate efficacy to a reasonable standard, how will X-raying a patient lead to a therapeutic benefit? In addition, since the positive effects seen for some sort of back pain are only comparable to conventional treatment where no X-ray is required, surely there is always an alternative treatment plan that does not involve exposing the patient to the risk of ionising radiation?”Excellent point. It makes you wonder why the (Royal Charter-seeking) College of Chiropractors devotes an entire faculty to radiology:
http://www.colchiro.org.uk/default.aspx?m=21&mi=156

FYI, back in 1998, Edzard Ernst also queried chiropractors’ justifications for taking radiographs:

Quote:
“The validity of chiropractors’ X-ray diagnoses is not well established. Small vertebral displacements or malalignments have no proven clinical relevance, dynamic studies have no proven value, and plain radiographs yield little relevant biomechanical information

-snip-

In conclusion, the current, albeit incomplete, data suggest an overuse of spinal radiography by the chiropractic profession.”

http://bjr.birjournals.org/cgi/reprint/71/843/249.pdf

29 January, 2009 11:44
Blogger zeno said…
Another brilliant article, Andy. I don’t know how you find the time – but I’m glad you do.

29 January, 2009 13:28
Anonymous Anonymous said…
With regard to enforcement:

The Healthcare Commission took over the role of the IR(ME)R inspectorate relatively recently, and I get the impression they are still catching up. They are doing pro-active inspection of radiotherapy facilities, where much higher doses are involved. So unless there are complaints made (or notifications of ‘doses much higher than intended’, but I don’t think that’s going to happen in the case of chiropractic), I doubt they are going to do much soon.

The HSE enforce the Ionising Radiations Regulations 1999. These come under the Management of Health and Safety at Work regulations, and as such specifically exclude those undergoing diagnosis or treatment. So unless chiropracters are using inadequate shielding for their X-ray rooms or something like that, then the HSE have no interest.

Which leaves trading standards, who, as you say, don’t have the expertise.

Ho hum.

S.

29 January, 2009 19:27
Anonymous Simon said…
You say that “Clearly, the majority of Chiropractors are X-raying fairly regularly and some are performing it routinely.” But I am not convinced of that at all. The reading of the data doesn’t suport this assertion as strongly as you imply.

There are two key parts of the data to look at. Firstly there is the question “For what percentage of your patients is an x-ray justified?”, to which 61% of Chiropractors responded that 1-20% of their patients fell under this category. 20 percentage points is a large range for such a majority of respondents to fall in to. On the one hand you could say that the majority of Chiropractors see that around 20% of their clients need to be X-rayed. On the other hand, it may around 5% The data is not specific, and an open ended answer choice would have been more illuminating.

Secondly there is the question “Do you take x-rays of your patients?” to which 63% responded no.

The conclusions here are that Chiropractors overwhelmingly see that a minority of their patients (20% or less) require X-rays, and the majority of chiropractors do not carry these out.You can easily make an argument that Chiropractors usually recognise when cases are beyond them and require real treatment and refer them elswhere. Looking at the source document this data came from 76% of Chiropractors refer 1-20% of new patients to their GP. I have no doubt that the Chiropractors also claim that their clients need complementary Chiropratic treatments, but what appears clear to me is that Chiropractors do not use X-ray on a regular basis, and will refer clients elsewhere for these X-rays.
Considering the neccesarily small sample size for the survey I think that it is a stretch to make your assertion of wanton and widespread X-ray abuse.

What I did find noteworthy in the survey was the question about whether or not Chiropractors would be willing to be involved with a private organisation such as Boots or BUPA in providing care, to which 74% responded positively (pg 21). Less than half that figure (percentages not given) wanted an association with the NHS.

02 February, 2009 15:49
Blogger Le Canard Noir said…
You are right that the data is not sufficient to be too specific about the rates and nature of self-referred and self-administered x-rays for chiropractic purposes. But it does look like the majority are either taking and/or refering for x-ray examination with nearly 70% ending up interpreting x-rays themselves. The law will require chiropractors to justify the exposure whether or not it is them pressing the red button.

Looking at the Ernst study (ref above) earlier BCA figures show 82% of UK chiropractors had X-ray facilities and 71% of patients were X-rayed for lower back pain. Another later survey found 74% had their own facilities.

However you dice the numbers, my post is really arguing that any X-ray administered for Chiropractic purposes cannot be justified on benefit grounds and so is possibly breaking the IR(ME)R regs.

02 February, 2009 16:18
Anonymous Simon said…
Your central thesis about the legality certainly seems sound, but you seem to be cherry picking weak data in the same way that quacks are rightly castigated for. The Ernst study found that of the 48 chiropractors surveyed for the period of 1973-74 83% had X-ray machines. It goes on to say at the end of the paragraph you selectively quoted from that “no data on the frequency of X-ray use were reported.”

If a good argument is supported by inadequate evidence then that argument can be seen to be invalid, no matter how strong it is. The argument that X-ray is not necessarily widespread amongst chiropractors, but that the significant minority who are using it are doing so illegally is a sound and persuasive argument. Why cling to an assertion that is not vital to your argument and does nothing to bolster it?

03 February, 2009 20:12
Blogger Le Canard Noir said…
Maybe you are right Simon, and I hope so. I do wonder though what all those X-ray machines are doing.

Perhaps, we can agree that it would appear to be important to have some independent review of how widespread X-raying really is.

03 February, 2009 20:40
Anonymous Simon said…
I can certainly get behind an independent review, but I’d be even more behind tighter registration regarding the use of X-rays. I know someone who is training to be a chiropractor and the idea that they would be allowed to operate such machinery fills me with horror.

03 February, 2009 22:35
Anonymous micko said…
I have had back pain patients ‘referred’ to see me (a pain medicine specialist)via their long-suffering GP because ‘my chiro said I need an MRI because I’m not getting better with his care’.

When asked what the chiropractor thought might be picked up on the MRI, the answer was that ‘the x-rays he has been taking don’t show all the nerves and stuff’. This patient had been subjected to fortnightly x-rays to ‘track the progress’ of the treatment over a three month period. We’re talking about abdominal x-rays here. What is worse, the GP had felt pressured to provide the referrals for the x-rays so they could be done by under Medicare (this is is Australia)

Now they wanted more speculative tests because they had reached the logical conclusion of applying ineffective treatments to imaginary conditions. Thankyou Le Canard Noir for bringing up this area of appalling waste and unneccessary irradiation for public discussion.

09 February, 2009 22:19
Anonymous TomB said…
The issue that seems to be missing here is “what exactly are chiros looking for on these radiographs?”

I’ve never heard 2 DCs agree to what was on an xray. There is no real chiropractic radiographic standard.

What does a “chiropractic subluxation” really look like?

14 February, 2009 18:45
Blogger CBrad said…
On the side of Chiropractors (of which i am not) maybe you should take a look at the actual Chiropractic degree course in the UK. It is an extremely medical sided degree with much of the course being equivalent to the modules undertaken in medicine. It seems that people never take notice to this… General diagnosis, neurology, radiography, Biology, Body mechanics, health & disease and so on. Chiropractors are also taught how to diagnose diseases. They are clinical professionals.

16 March, 2009 12:50
Anonymous Blue Wode said…
Which chiropractic degree course? There’s more than one:

Quote
“There are three institutions in the UK offering chiropractic courses. They offer either a BSc honours degree or a Diploma. Two of the institutions describe themselves as a “college of chiropractic”, and the other, the University of Glamorgan, has seen fit to offer a BSc [Hons] Chiropractic amongst its degrees (interestingly listed under “health science”).

The worth of a degree in a subject that cannot prove its basic tenet, the subluxation, seems rather dubious. The fact that an established university is prepared to offer such a degree may be a reflection of the cash-starved situation universities are in; however, it can only diminish the university’s standing and reputation to so do.”

http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

Indeed, the Quackometer has already blogged about the very dubious McTimoney College of Chiropractic which, in addition to offering a BSc in chiropractic, offers an MSc Chiropractic (Small Animals)and an MSc Chiropractic (Paediatrics):

Quote:
“One of the recurrent criticisms of chiropractic is that it is founded in mystical ideas and has a very poor evidence base for the efficacy of any of its treatments. The McTimony Chiropractic Association, based a few miles from Abingdon in Wallingford, sheds little light on the evidence for the efficacy or superiority of their chiropractic variations on thier web site. The philosophy of McTimony is given as “McTimoney taught, as DD Palmer had before him, that health depends on healthy nerve messages, that subluxations of the vertebrae or other joints interfere with these, and that such subluxations can affect not only joints and muscles, but every cell and organ in the body. He also stressed what would one day be called holism: that human beings are not purely physical but mental, emotional and spiritual beings as well, and that treating the whole body restores health to all these aspects of the patient.” This looks like pretty fundamental chiropractic with their mysterious and unproven ‘subluxations’ being the cause of illness – and not just bad backs, but the health of all ‘cells and organs’. The college appears to adopt this worldview. Its prospectus states, “The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.””

The Role of UK Universities in Chiropractic

NB. McTimoney chiropractors represent at least 25% of UK chiropractors.

And even if one or more of those degrees are to some extent medically-oriented, as you suggest CBrad, I suspect that they represent a useful (semi-)scientific smokescreen behind which many chiropractors hide once they enter clinical practice and decide to fall back on DD Palmer’s original ‘philisophical’ style of chiropractic.

16 March, 2009 15:47
Blogger CBrad said…
I agree that my comments were general given the different branches of chiropractic however having studied engineering alongside many friends studying chiropractic at the University of Glamorgan i have first hand experience of the course material and in depth study involved with not just medically oriented study material but actual medical modules on par with those undertaken by other friends of mine taking medicine.

Many of my friends are set up in practices now and the medical practices are very much in place. Even though they have left University the medical study doesn’t stop with continuous learning a must… especially in clinical diagnosis.

Patients visit and often are diagnosed just as if visiting a GP. I believe it is this side of chiropractic that gives chiropractors the primary health care status that they have achieved in the UK.

The Clinics build good relationships with local medical practices and refer between them.

There’s more to modern chiropractic than subluxation’s.
Many visit their Chiropractor for reasons others visit their GP.

On the x-ray side of things i can’t speak for all branches of Chiropractic but certainly with my friends they adhere to the same guidelines as with medicine.

As for comments by Ernst… many paper articles of his have been retracted due to inaccurate comments and biased views.

18 March, 2009 16:13
Anonymous Blue Wode said…
CBrad wrote: “Many of my friends are set up in practices now and the medical practices are very much in place. Even though they have left University the medical study doesn’t stop with continuous learning a must… especially in clinical diagnosis.”

Yes, it’s very interesting to read what’s considered Continuing Professional Development (CPD) for chiropractors. For example, by attending this conference they can notch up a whole 7 hours of CPD:
http://www.united-chiropractic.org/modules/mastop_publish/files/files_492ae1b774609.pdf

CBrad wrote: “The Clinics build good relationships with local medical practices and refer between them.”

Considering that most chiropractors in the UK work in private practice, of course they’ll try to build good relationships with local medical practices. It’s an excellent way of drumming up business.

CBrad wrote: “There’s more to modern chiropractic than subluxation’s. Many visit their Chiropractor for reasons others visit their GP.”

Sadly, you seem to be correct with your latter point:

Quote:
“Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents. Statistically significant differences between chiropractors of different associations in the UK were present, particularly regarding the benefits of chiropractic treatment for non-musculoskeletal conditions…..Traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents and 63% considered subluxation to be central to chiropractic intervention.”
[Ref: Aranka Pollentier and Jennifer M. Langworthy, The scope of chiropractic practice: A survey of chiropractors in the UK, Clinical Chiropractic, Volume 10, Issue 3, Pages 147-155. September 2007]

CBrad wrote: “As for comments by Ernst… many paper articles of his have been retracted due to inaccurate comments and biased views.”

Then would you please give details of at least 5 of his articles that have been retracted. Thanks.

19 March, 2009 12:28
Blogger Le Canard Noir said…
CBrad represents everything that is wrong with chiropractic, in my opinion. There is a belief amongst chiropractors that their studying is equivalent to medical degrees. An insider at a local chiro college tells me that the students believe they are studying post-graduate level material – utter codswallop. They are taught simple anatomy and then false information about subluxations. The principle of the college teaches mainly business practice.

And then people like CBrad go away believing that their clinical competence is somehow equivalent to a GPs and they allow their customers to believe such things too. Despite the complete lack of evidence that chiropractive is effective for any condition bar lower back pain. And then thay are also allowed to believe made up things about their critics like Ernst. (Still no listings of retracted papers…)

26 March, 2009 11:22
Anonymous Ynot Cod said…
Thanks for the opportunity!
Now recognised within mainstream education, the syllabus within chiropractic institutions has the same academic rigour applied as all other. The description of an “insider” at a college might need just a little more substantiation.
Ernst is a self-styled “Professor of Alternative Medicine”. Nothing wrong with that, although he actually enjoys no support or credence whatever within complementary or alternative medicine and –and certainly not with leaders of -or authorities on- any discipline. Nothing wrong with that either, but common sense might prevail when choosing whose judgements to accept (covered later in this piece).
Undergraduate chiropractic education actually makes very little mention of the vertebral subluxation –although there exists a tremendous amount of information about such within college and institution resources(invariably available for public scrutiny). The basic tenet of chiropractic describes the removal/correction of nerve interference caused by misaligned vertebra(e). Anyone with even a very elementary knowledge of spinal anatomy will find this easy to understand -properly qualified chiropractors have a comprehensive knowledge of spinal (as well as whole body) anatomy and physiology (covered later in this piece). For many chiropractors, after years in practice -sometimes thousands of cases- the concomitant health improvement coincident with improved spinal movement cannot be ignored. This is, of course, a very different perspective on health for those who truly believe that the body is actually designed to malfunction and/or that the only true gatekeepers to health are those who render medications or surgery. Inevitably, in stark contrast to those who believe the body is essentially a self-rectifying organism occasionally in need of some assistance.
In fact there are very few recurrent criticisms about chiropractic. There are frequently repeated unfounded impugnments by those not properly vested to make such assertions –these are patently not “recurrent criticisms”. Subluxation -as a concept- is not really difficult to understand, it is “less than a luxation” (Oxford dictionary). If luxation is not part of one’s lexicon, the acceptance of the concept of luxations and subluxation could present something of a challenge. That said, not all chiropractors accept the concept of subluxation!
It is simply inaccurate to allude to a poor evidence base. Thousands of hours and vast sums of decent and honest funding for properly conducted double blind scientific research has demonstrated the efficacy of spinal correction for pain relief, posture correction, enhanced body performance and many other improvements. These studies have been performed both within the profession and without. In stark contrast to pharmacological trials funded by pharmacological companies.
In the main, chiropractors are intelligent, highly educated, open-minded, well meaning people (who like to sleep at night) doing much good for millions of extremely grateful people around the world. Unfounded criticism by the intelligent, educated, articulate, verbose, uninformed probably has the most profound deleterious effect on those of a similarly closed mind, who (some may say perversely) similarly may never be able to enjoy life to the full because of their spinal problems.
There are thousands of people on the periphery of chiropractic -educators (high level specialists, Ph.D.s etc -not all of whom are chiropractors), support staff, referrers, referees, medical insurance companies, adjudicating bodies etc.. Many chiropractors are re-trained professionals from other disciplines:- science, medical, dental, legal etc. (invariably self funding their own re-education). There are millions of people worldwide enthusiastically benefitting from chiropractic care –including hitherto naysayers turned beneficiaries (including thousands of chiropractors), among the highest achieving sports professionals, medical doctors, legal professionals, scientists and myriad academics. Whilst one can appreciate the perspective of those from the outside looking in will always be different, would the open-minded intelligent unbiased seriously contend all of these people have been -and could be- duped since 1895?
One makes this submission on the basis that other respondents will be open-minded enough to at least consider these points. One would never wish the problems chiropractors deal with on another person, although many hitherto naysayers have had their lives dramatically changed by resorting to open-mindedness!
07 April, 2009 09:32
Anonymous Blue Wode said…
Ynot Cod said: “Whilst one can appreciate the perspective of those from the outside looking in will always be different, would the open-minded intelligent unbiased seriously contend all of these people have been -and could be- duped since 1895?”

Yes.
http://sram.org/0302/bias.html

07 April, 2009 12:32
Blogger Le Canard Noir said…
Well, Ynot Cod. Where to start. Your depiction of Ernst is pretty appalling. Is Ernst a ‘self-styled’ Professor of Alternative Medicine? Of course not. He was appointed to the Laing Chair in Complementary Medicine, Peninsula Medical School to test the claims of alt med using the tools of science. Unlike chiropractors who ‘self-style’ themselves “Dr”. The irony.

The low opinion of Ernst amongst the alt med community is of course no reflection on his character or standard of work, but an appalling reflection on the level of engagement with science amongst practitioners and those who financially gain from quackery. His research and systematic reviews are unmatched in the academic world of alt med. Quacks do not like him because he threatens their cosy world by pointing out when they have no evidence for their claims, or their claims have been disproven.

You then say that “Undergraduate chiropractic education actually makes very little mention of the vertebral subluxation”. Here is a link to the Abingdon prospectus: http://tinyurl.com/dbnkfn. Note how they refer continuously to subluxations. I know some chiropractors are embarrassed by this pseudoscience, but the McTimoney lot are not, are they? You may wish to describe it in the more plausible sounding words of ‘nerve interference’, but that does not make it true. There is no evidence to support the chiropractic dogma that somehow disease is generally caused by such ‘nerve interference’ and that cracking bones cures these diseases or that ‘preventative maintenance’ makes you healthier.

“It is simply inaccurate to allude to a poor evidence base. ” Can I refer you to this site? http://tinyurl.com/clgs7q.

Chiropractors appear to have a habit of not citing their wonderful research reviews. When a writer recently noted that the evidence base for chiropratic cures of childhood ear infections was non existent, they decided to sue rather than cite their evidence. Ernst has done a lot of reviews of the evidence base for chiropractic (e.g. “A recent systematic review restricted to chiropractic manipulation included only eight randomised controlled trials, all of which were methodologically flawed and “did not provide convincing evidence for the effectiveness of chiropractic” “, http://tinyurl.com/cqv32v). Where is your evidence that there is a good evidence base?

And as for your claim that all these people could not be duped since 1895 – well many of us have not been duped. And people are duped all the time – e.g. homeopathy – for 200 years.) Your disbelief in the gullibility of people is not proof of chiropractic.

As for ‘open mindedness’. Asking for evidence for extraordinary claims is not ‘closed minded’. Perhaps you would like to look at this rather good exposition on the subject: http://www.youtube.com/watch?v=T69TOuqaqXI

And, would you like to declare your own interests here? Are you Tony Metcalfe by any chance?

07 April, 2009 14:00
Anonymous Anonymous said…
Homeopathy… I believe this is proof under a different guise… Science.

http://news.bbc.co.uk/2/hi/health/7899383.stm

Proof isn’t always under the same name as that in dispute.

Chiropractic evidence isn’t always there under the guise of chiropractic either.

There are many things chiropractors do that are already proven elsewhere medically but never does the word ‘chiropractic’ come into this.

For instance… recovery plans that incorporate stretching, strengthening and toning of muscular problems and muscular skeletal issues to aid recovery(physiotherapy).
Or how about advice on eating healthily, exercise and general wellbeing.

I would also like to add a little point on the side of common sense and from another discipline… mechanics.

If you have a machine with many moving parts and some of those parts are out of alignment it is obvious to say that over time that causes wear and tear and potentially affects other parts of the machine. If left uncorrected those parts in the machine will become damaged and possibly wear out needing replacement. If realigned early enough any problem can be avoided but if left too long damage can become irreversible.

The body is also a mechanical system (Bio mechanical) and medicine already knows that if used incorrectly it can cause damage to tissue, joints and the nervous system. Even stress and physical tension can lead on to cause other issues. The difference with the body is that it has the ability to heal itself… unless left too long and the damage then is irreversible. Bad posture can cause headaches, back problems and so on.

So if these issues are correctly resolved i.e. posture is corrected and maintained then the other issues tend to go away and the body has an opportunity to heal the wear caused. This seems quite natural to me. Isn’t this what chiropractic aims to do… correct issues and allow the body to naturally heal itself along with supporting that healing with exercise and maintenance plans?

15 April, 2009 11:07
Blogger Le Canard Noir said…
Dear Anonymous – I hope this isn’t what chiropractors take for evidence.

Just because a chiropractor might be right in suggesting a sensible diet does not mean that everything they say is correct. Common sense, unfortunately, should not form the basis of evidence. Science exists for this very reason that so much of what we know about the world is actually counter to our ‘common sense’ view of it. If we could just intuit what is true then there would not be any need for experiment, evidence and reason.

What might seem natural you actually demands evidence. Chiropractors have little.

Oh, and PS. The BBC link you supply has nothing to do with homeopathy.

15 April, 2009 11:33
Anonymous Anonymous said…
Le Canard Noir- Just because a Doctor of medicine says that exercise is good for you or that a sensible diet would be of benefit doesn’t mean that they are always right either. That is just a fact of being human. Science is just as susceptible to being wrong. Science says that this is true only to prove it wrong and reinvent fact.

My point with the BBC article wasn’t that it was all about homeopathy but rather in science there exists evidence not under the ‘chiropractic’ or ‘homeopathy’ banner that bares relevance to base concepts of that banner. Homeopathy uses a core concept of treating like with like. The article is a scientific aspect of treating like with like. These studies aren’t done under the banner of chiropractic or homeopathy however whatever your views on subluxation or energy flow or whatever belief system accompanies a therapy there does exist evidence of the core theories behind these.

Its a shame that you don’t judge the whole. If you are so evidence based the evidence of all the additional clinical side of chiropractic would add to the whole of your viewpoint.

You concentrate on subluxation as flawed but chiropractors have different offshoots of the profession. As discussed already there is the McTimoney branch as well as the more medical orientated and clinical side of chiropractic of which i am accustomed. It would be rather broad to say that all medical doctors are the same.

I find my chiropractic clinic much more professional than my GP practice and my Chiropractor much more thorough than my GP.

16 April, 2009 17:35
Blogger Le Canard Noir said…
Anonymous – so many canards, so little time…

1. I do not claim doctors are always right – such a claim would be ridiculous. But chiropractors stand a high chance of being always wrong when talking about subluxations – as there is no evidence that chiropractic subluxations exists. They are an unproven and doubtful hypothesis.

2. Science is just as susceptible as being wrong as what? Science is the best method we have of determining the truth about the world. If you know a better method, then let us know. Wishful thinking is not one of them.

3) Your BBC article has nothing to do with proof of homeopathy. Just because desensitisation with pollens was being used, does not mean that the homeopathic principle of ‘like-cures-like’ is generally true. Desensitisation uses tiny amounts of allergens to ‘train’ the body. Homeopathy uses non existent amounts of substances to do something magic. And in anycase, using pollens is isopathy not homeopathy. Many homeopaths would be angry at your confusion!

3) McTimoney os heavily subluxion centred. Do you know what you are talking about?

4) Your chiropractic clinic may be much more professional than your GP practice. Much more professional at taking money off you.

16 April, 2009 21:28
Anonymous Anonymous said…
I would just like to point out that the GP isn’t free. We pay for that out of our taxes and have to pay that regardless of whether we go to the GP or not. Whatever your view on chiropractic the option to pay for treatment is still that… an option. If it works for a person then they will continue. It beats seeing a GP that doesn’t even look me in the eye nevermind examine me before dishing out so called cure all pills.

Personally i get relief from treatment (albeit without so called scientific proof that you talk about). whatever that relief is i am happy with it. I have never been forced into paying for anything. I have always been given well explained options and being an educated person i make a decision that suits me.

Good luck to this continuing debate on both sides!

17 April, 2009 15:36
Blogger Le Canard Noir said…
I wish people would not use ‘Anonymous’ – it shows that not much thought is going on. How can we have a conversation when it is not clear who is responding?

Anyway, the problem with chiropractic 9as with much quackery) is that it is very easy to fall into the trap of thinking that it is working. Take my bad back. I have had a bad back on and off for ten years. It is much, much better now that it used to be with only occasional mild problems. It would flair up for a week or two, really affecting me badly and then get better. All I have done is follow my doctor’s advice of taking pain killers and keeping active.

Now, what if I had rushed to my chiropractor at each flair up? Indeed, my back would get better (as long as he did not make it worse). It would be so easy for me to believe that it was my chiropractor sorting out my subluxations. But it is not. Chiropractors depend (whether they know it or not) on the fact that aches and pain and illnesses mostly get better and that we visit them when things are bad. The only way for the illness to go is to get better. One more sucker hoodwinked into lengthy and unnecessary treatment from a quack.

So, how do you know you get relief from treatment? Are you confident and self-assured enough to think that you too cannot make mistakes?

17 April, 2009 16:15
Blogger Maureen said…
you guys waste your time with your lousy unfounded premises, as well as bitter taste of common decency. Simply put some friggin idiot who doesnt know any better and has absolutely 0 credibility started the whole quack concept in which all of you little followers jumped on because quite simply its easier to follow that than to stop and think about what is really going on out there…patients are getting better. ANSWER THIS for me, what country has the most advanced medical system? United States right? well why are we also the sickest country in the world! hmmm…whats the #1 leading manmade cause of human deaths in the united states…MD’s. brainwashed!!! its ok to be skeptical but some of you are just outright lashing out!

15 May, 2009 02:16
Anonymous Anonymous said…
It would take you the next 20 years of your bitter life to read all the material proof that mobilization of the spinal column has a better chance of improving the quality of life of the whole human than all other treatments combined. My brother is a medic. and freely admitts that in his education at Northwestern University in Chicago he was not shown thing one about how to examine the integrity of the spine or any other articulation in the human body. The PDR gives information on the nutrient depleting effects of hundreds of drugs and yet when was the last time you heard anyone tell you that their doctor gave them warnings or advice about nutrition with thier scrip. It’s odd too that the fact that the mechanisms of most of these drugs are not clearly known and the resultant deaths ( in the thousands per year ) would not supercede your jealous wonderment about the success of Chiropractic in every arena it enters. I have never advertised my services as a Chiro and yet 50-60 people per day beat my door down. I can’t get away from them. They love the way they feel and I won’t go into specifics about the results because you would dismiss it as hear-say. Tell that to the man that threw up six times a day for months until his first and only spinal adjustment a week ago. Ethan Hagen DC said

14 September, 2009 17:19
Anonymous Zeno said…
Anonymous said: “It would take you the next 20 years of your bitter life to read all the material proof that mobilization of the spinal column has a better chance of improving the quality of life of the whole human than all other treatments combined.”

…and just five minutes to read all the decent scientific evidence.

14 September, 2009 18:08
Anonymous Anonymous said…
whoever wrote this article must be a medical doctor with know knowledge about chiropractor- ask yourself how a doctor would treat back pain-with a pain killer to cover up the problem-whereas we fix the problem. Whats this rubbish about innate intelligence- im studying chiropractic and its an evidence based mechanically based profession-get a life!

28 January, 2010 12:09
Blogger Le Canard Noir said…
Your spelling, punctuation and critical thinking abilities are a credit to your chosen profession.

28 January, 2010 12:23
Anonymous Anonymous said…
Le Canard Noir,
I was looking at your post from 16th April…
About this subluxaton complex- do you know anything about it?-clearly not. Out of interest do you have an education in a medical or chiropractic background?
If not then you really have no position to be making a judgement on chiropractic. You are one of those people who picks out the information that they want to convey amongst the public, and ignores success rates for say low back pain treatment…
If we think about how many wrong diagnosis medical doctors make, but these aren’t publicised because uneducated people like you don’t feel they need to prove a point.
As muchas you want to deny it, your view is very opinionated and I suggest you go and observe a chiropractor in clinic for say a week, and then get back to me.
And, as regards to the money, medical Doctors eg GP’s earn a great deal more for prescribing pain killers to a range of mechanical problems, that a chiropractor can fix, with which there is EVIDENCE.
In fact, do you even have an education-you seem extremely irrational in your reasoning.
all the best, D.M ( the sight won’t let me post as anything but anonymous)
28 January, 2010 14:16
Blogger Le Canard Noir said…
I find it amazing amongst quacks how their universal response to criticism is ‘shut up, shut up, shut up’.

I do not need to have studied chiropractic to make criticisms of it in the same way that I do not need a PhD in Invisible Imperial Textile Manufacturing Techniques to point out that the emperor has no clothes.

My views are not ‘opinoionated’, but informed by evidence. What is your evidence that GP’s earn money from prescribing pain killers (are you UK based?) What is your evidence that your victorian-fare-ground-back-cracking-trick-turned-pseudomedical-specialism can perform better than pain killers or other treatments for lower back pain?

28 January, 2010 14:38
Anonymous Anonymous said…
There are plenty of evidence and articles on medlink, AMED, Manti and ICL about the effectiveness of our treatment, and the first hand evidence comes from doctors i have spoken to that admit we are experts in a field that they are not and are awaiting to chiropractic to come onto the NHS(that explains your question that I’m UK based).
The fact that you have no actual experience of or in chiropractic tells me that I may be wasting my time talking to you. You obviously don’t know the specificity and skill of adjusting the spine and so i find this amusing that you claim to be so right, you really have no expertees to base your judgments on. I politely ask you get some first hand expericne observing clinical practice of chiropractic, because adjusting the spine(or manipulating as you may have heard it)forms just part of our treatment. Then please come back to me.
Why don’t you go and ask why lets say A.C Milan and all big clubs employ chiropractors, because do you think we’de be trusted with players worth millions of pounds if we didn’t work?
Not being rude, but people need to be educated!
All the best, D.M
28 January, 2010 15:02
Blogger Le Canard Noir said…
You see, I view chiropractic as a pseudomedical cult and I am aware that their fanzines have produced many ‘positive’ studies, much in the same way that you can find similar results for nonsense therapies such as homopathy. Allow chiropractors to cherry pick the studies that suit them would be an unwise way to assess the effectiveness of the treatments.

However, when independent systematic reviews of performed of this literature, such as Ernst and Canter (2006) a very differnt picture emerges. They concluded,

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.

Because you appear to be inside this cult, you will of course be very hostile to external criticism, as all cults are.

Football clubs can fall into the trap of believing your sales pitch too. They are not an authority by which one should assess the effectiveness of medical treatments, are they now?

28 January, 2010 15:23
Anonymous Anonymous said…
I understand where you are coming from, but if you have no experience in chiropractic then you cannot claim that it’s utter nonsense, obviously studied show that some approaches are unsuccessful but then what about drug testing? If something is harmful or inneffective then the drug is not approved, and whereas with certain techniques, if they don’t work they are disgarded. We aren’t a group of professionals that ignore everything that we face, but we wouldn’t exist if we weren’t experts and weren’t effective in our field. If you could get some experience observing, you may see in a slightly different light considering you haven’t done so before i am assuming, as all you seem to talk about is studies.
Regards, DM
28 January, 2010 15:33
Blogger Le Canard Noir said…
It is simply not true that because you say that I do not have direct experience of chiropractic then I cannot have an informed and valid opinion of it. Perhaps you missed by argument about the emperor’s new clothes. You do not need to have studied mythical creatures to believe unicorns do not exist. We can rule out all sorts of claims, such as dowsing, homeopathy, astrology and physic reading without spending years studying the arcane nonsense of these subjects. We can rule them as suspect or even nonsense on a priori grounds.

What would observing a chiropractor at work achieve. I would no doubt see patients saying their backs had got better since their last spine wizard visit. But bad backs tend to come and go anyway, so should I take their testimony at face value?

It is a common trait of quacks to value direct experience over more objective and controlled studies. And that is why their beliefs survive. But we know that people’s interpretations of direct experience can be thrown by all sorts of fallacious reasoning and biases. That is why it is so important to assess evidence through objective tests as carefully as possible.

28 January, 2010 16:03
Anonymous Anonymous said…
Bo yeah fool!!! Lighten up Le Canard Noir, your not french are you? Just a joke. What is your profesional background to judge chiropractic in such a negative way? Plus whats up with your negative obsession with manipulation, can you tell me you haven’t had a time where you have a “stiff neck” and it “just cracks” naturaly and it must have just felt a little bit better? honestly? (not saying thats what an adjustment is, seeing you know so much about “cracking” and how it has no effct). You also must be forgetting all the other problems that chiropractors these days are able to diagnosed. Which there have been cases where chiropractors have diagnosed pathalogical as well as mechanical disorders that GP’s have missed. The health care system should work together as a holistic approach to sort people out and not just realy on placebo drug treatment, which does work but i’m confident in my knowlege of this so i’m not gona waste my time in drawing up quotes from previous studies studies, due to this being on a quick comment on how narrow minded a lot of these comments are and how hostile everyone is with eachother. Just chill out and go and experiance the real things and then draw up a conclution rather than looking at statisical ratios and all that stuff, life and real treatment (treatments in general including GP’s)does not exist in experimental mock ups of situation. Things work differntly in real life than on paper is what im getting at.

As a final comment i’m not gonna reply to any comments, I just seen this and thought I would back up DM on this situation.

oh cheak out this link
http://www.youtube.com/watch?v=jHPOzQzk9Qo ~

28 January, 2010 16:34
Blogger Le Canard Noir said…
You make my points for me.

28 January, 2010 16:56
Blogger Richard said…
Hi Andy,
Your are perfectly entitled to your opinion, and like noses we all have one.However In your article you state “Subluxations are suppose to block the flow of ‘innate intelligence’ around the body. This is a mystical notion with no basis in science.Whether or not Chiropractors believe this nonsense, taught to them under the watchful eyes of British Universities”

The Anglo European College of Chiropractic and the Welsh Institute are the only Uk chiropractic colleges recognised internationally. What evidence do you have for the above statement. In fact if you can produce evidence that this has been thought at either college, I will give you £100. Lets call it the sceptic challenge, produce your evidence?

In those two colleges they do teach about homeostasis which you may be confusing with “Innate Intelligence” not sure I know what the difference is myself. So are you saying spinal joint dysfunction does not interfere with hoeostasis and is a “mystical notion with no basis in science”

29 January, 2010 10:54
Blogger Le Canard Noir said…
I think it is fascinating that so many chiropractors are trying to deny the subluxation now. What I believe is happening is that language is being changed, but central beliefs are not. The terms ‘subluxation’ and ‘innate intelligence’ are giving way to more modern scientific sounding names – but core beliefs remain unaltered. Its all a wash of pseudoscience attempting legitimacy through language.

Of course, I do not have access to these cult training camps teaching materials. But there is plenty of strong evidence to suggest that subluxations are still being taught. A few seconds googling reveals people taught there saying they have been trained at AECC and: “four or five year university chiropractic degrees which have trained them to practise safely, identifying and correcting spinal subluxations(spinal misalignments).”

http://www.the-chiropractors.co.uk/ourstaff.html

I think that is sufficient to claim £100.

And what is even more interesting is how to cherry pick your colleges. You know full well there are three recognised colleges in the UK, but you try to pick two that hide their beliefs a little better. The McTimmoney college is far less circumspect in stating it teaches subluxations as you well know. (see the prospectus: http://www.mctimoney-college.ac.uk/documents/Human-prospectus-Updated-July-2008.pdf)

The 2004 GCC survey also had lots of chiropractors trying to say that the subluxation was central to what they did. Interestingly, the GCC also refused to ask questions mentioning the forbidden term, but the responses were far more revealing, e.g.

“The leaflet is good but I feel there is a gap in the major area of subluxations affecting nerves. This is after all the basis of
our philosophy.”

http://www.gcc-uk.org/files/link_file/ConsultTheProfession.pdf

As with all cults, the message you give to the outside world, and the messages you give each other internally, can be very different. You do not fool me.

Email me for my postal address so you can send the cheque.

29 January, 2010 12:14
Anonymous Richard Lanigan said…
Andy, as you know I do not deny the existence of a vertebral subluxation or spinal dysfunction or what ever you wish to call it, or the effect joint dysfunction has on mechano receptors and how that connects to the central nervous system and homeostasis. I have tried to explain it to you without success. So I am happy to agree to disagree with you on that one.

We are discussing your comments about what is thought in two UK chiropractic colleges.
You said “Subluxations are suppose to block the flow of ‘innate intelligence’ around the body. This is a mystical notion with no basis in science. Whether or not Chiropractors believe this nonsense, taught to them under the watchful eyes of British Universities”
You repeat that mantra in your latest posting “there is plenty of strong evidence to suggest that subluxations are still being taught”.
I went to college with Charlie and Annette who you refer to. We were taught to palpate the spine to locate spinal joint fixation and perform spinal manipulation to treat back and neck pain. Subluxation theory is not thought at AECC or the Welsh institute, period. I wish it was, you wish it was, but it is not. Shouting it from the rooftops will not make it true, it only makes people who went to chiropractic school in the UK laugh at you.
I was trained at AECC however there are many chiropractors who would be mortified were you to assume they were like me, cant you see how idiotic it is to assume all people who trained as chiropractors conform to this stereotypical image you have of chiropractors. Are all sceptics the same, surely not, there must be a few who can think for themselves.
You say
“ what is even more interesting is how to cherry pick your colleges. You know full well there are three recognised colleges in the UK, but you try to pick two that hide their beliefs a little better”.
Andy its you that cherry picks your colleges and displays your lack of knowledge of chiropractic education or the chiropractic profession in the UK. In your posting on chiropractic education you focus exclusively on McTimoney. The vast majority of British Chiropractors do not want to be on a register with McTimoney chiropractors. Their college is not recognised by any chiropractic body outside the UK. The Government insisted on one body of chiropractors as the price of the Chiropractic Act.
The BCA have gone as far as banning their members from teaching at McTimoney. I did not have a problem with McTimoney’s approach to chiropractic, however their leadership let themselves down instructing their members to remove their websites and unwilling to stand besides their GCC colleagues under attack, thats why I made public the instruction to McTimoney members to remove their sites.
To prove you cherry pick your academic institutions you will notice the European Council of Chiropractic Education does not list McTimoney college as an accredited college http://www.cce-europe.com/institutions.php
The European Chiropractic Union is having their converence in London in May http://www.ecunion.eu/default.asp you will notice on their home page this statement “Open to all chiropractors who have graduated from a CCEI/ ECCE chiropractic institution, practicing in a country that is not a Member of the ECU” McTimoney chiropractors are nor allowed to join the ECU.
Your faith in the British regulator to set standards for chiropractic is misplaced.

30 January, 2010 21:16
Blogger Le Canard Noir said…
Methinks you protest too much.

Your friends say it directly, “trained … to practise safely, identifying and correcting spinal subluxations”.

Where were they trained to do this then, if not at their college?

As I say, you are playing word games and using internal chiropractic politics to suggest that ‘we do not understand’.

Your friends are “Wellness” chiropractors – in the business of telling people they need spinal manipulation when they are healthy in order to keep them healthy. Their website says explicitly “Within this system is an in-born (innate) intelligence which controls the billions of chemical reactions which take place every second.” What is that but an expression of pretty much fundamentalist unreformed chiropractic gobbledegook – the sort you try to cover up with your rephrasing in more modern lingo?

And I also am not a supporter of the GCC setting standards, as you suggest. How can you set standards in nonsense? That is the very reason chiropractors are in such deep doo doo at the moment.

30 January, 2010 22:48
Anonymous Richard Lanigan said…
“Where were they trained to do this then, if not at their college?”
I cant speak for them. However as president of the Student Union, I attended the chiropractic centennial celebrations in 1995 in Davenport. Meridel Gaterman an “evidence based researcher” gave a presentation on her excellent book; Foundations of Chiropractic: Subluxation. I read it, in my opinion it is by far the best book that has been written on chiropractic theory. When I returned to AECC I began questioning the academic committees as to why this was not being thought at the college and why the curriculum was being medicalised. They said they wanted to distance themselves from the more traditional chiropractic education, particularly McTimoney college.
Back then hardly any chiropractors in the UK used the term “subluxation”. When I did my final exams at AECC you are given three case studies and you make a diagnosis and then give the differential (other possible diagnosis) . You could see the two external examiners giving you a tick on the mark sheet for each diagnosis they were looking for.
Being a rebel each time I was asked for the differential I led with “Vertebral Subluxation Complex” (VSC) not once did I get a tick, I was hoping I would be asked what is a VSC, I had my answer prepared, like you the examiners were not interested.
So you can repeat it as often as you like but none of the senior tutors at AECC or WIC use the term subluxation, in fact David Byfield who is the President of WIC shares your views on “Subluxation” look up his name on chiropracticlive. All the senior people in the BCA despise subluxation chiropractic, they are the frustrated medical practitioners and they ones who have the ear of NICE.
Ask Simon Singh if you don’t believe me, thats why in my opinion the BCA were being dishonest putting the claims on the website. The “scientific” evidence is weak and in my opinion they did it so to keep members who were questioning the biomedical model. The BCA are now stating publicly they want to move away from traditional chiropractic and want the prescribing rights offered in the Health and Social Care Act 2001. Thats why many chiropractors find this so funny. Simons comments were directed at the very people who have been trying to prevent the progress of Subluxation chiropractic in the UK. Your bedfellows in this debate about Subluxation chiropractic are, Richard Brown, Tony Medcalfe et al. Right now the BCA is the only chiropractic organisation in the world pursuing prescription right for its members, they have this in common with the National Association of chiropractic Medicine which may have folded last year. http://en.wikipedia.org/wiki/National_Association_for_Chiropractic_Medicine
Its not word games as we have discussed before, the curriculums at AECC and WIC are medicalised. taught by medical people and you are way off the mark if you think subluxation theory is taught there in any capacity, write and ask them they would love the sceptics to recognise they agree with most of what you say see Byfields expert testimony to the GCC, he called “Subluxation a clinical myth and nonsense, you would love each other.
To persist with this ridiculous idea that there are any similarities between the way I practice and say Richard Brown or David Byfield just shows you are simply prejudiced against anyone titled chiropractor and are unwilling to change your dogmatic beliefs.
To assume you must be right because of the way Charlie and Annette practice is like assuming Harold Shipman learned to murder people at medical school and everyone who studied there must be doing the same in their practice. To use you simplistic argument “Where was Shipman trained to do this then, if not at his college”
Think what you like about chiropractic, blame AECC and WIC for adding to the number of chiropractors in the UK if you like, but constantly repeating they promote subluxation theory or practice in the UK shows how little you know about chiropractic in the UK.
31 January, 2010 20:27
Blogger Le Canard Noir said…
Richard, your beliefs about chiropractors appear to be anecdotal, much like your beliefs in its effectiveness.

Research data may well make uncomfortable reading for you. Pollentier and Langworthy surveyed the trade in 2006 (Langworthy is from the AECC) and found that:

– only 47% thought science was more important than chiropractic philosophy.
– 76% thought chiropractic philosophy important to what they did
– 63% considered subluxation to be central to chiropractic
intervention.

Given the obvious efforts by many to hide chiropractic’s embarrassing origins, I would be worried that even these figures were under-representations of what real beliefs are.

Whatever your beliefs about the motivations of the BCA we see a so-called profession in turmoil – a possibly embarrassed leadership creating fig leaves to hide the pseudoscientific beliefs and un-evidenced practices of their memberships. Statutory regulation has tried to smooth over the deep fault lines and nonsense within chiropractic – and it is all surfacing now.

I think we might both agree that it is very interesting to watch where this is going.

01 February, 2010 12:32
Anonymous Richard Lanigan said…
Andy,
Is’nt that “Quack trick #39 – don’t talk about that, talk about this – ‘what-aboutery’ ” . I have no problem with my beliefs or the result of that survey. We can talk “about” how chiropractors came to these conclusions on my blog if you like.The fact is you were wrong, 100% wrong to “believe” chiropractors learned Subluxation theory at AECC or the Welsh Institute. Are you big enough now to admit you were wrong? I can’t stop you insisting we learned about subluxation theory at AECC, but it is not true and to keep saying it is foolish.

Did you ever consider these kind of statements which the BCA can easily prove are untrue could be damaging to Simon Singhs case. You may be sure the BCA are collecting this type of statements from the internet. You will be relieved to know I have nothing more to add to this here but will take it up on my own blog when I see what you do.

01 February, 2010 20:55
Blogger Le Canard Noir said…
I stand by what I have said – that chiropractors are still learning subluxation theory – they may have changed their vocabulary, but that is all. It also appears that most appear quite happy to revert to their core philosophical vocab in the real world, as I have quite clearly demonstrated.

02 February, 2010 00:41
Blogger EmpiricalScience said…
When it was founded in the early 1900’s this was true ‘chiropractic … is founded on pre-scientific views of the body (innate intelligence flows though our nerves), a discredited model of illness (subluxations’. It is also true that orthodox medicine is founded pre-scientific views of the body containing only 3 basic elements and a discredited model of illness (fire or fever in the blood)which should be purged by bleeding. The former statement is no more a reflection of modern chiropractic than the later is reflective of modern medicine. This kind of lazy statement instantly lacks credibility as a logical argument.

‘Chiropractors are taught that “The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.” Subluxations are suppose to block the flow of innate intellegence around the body’. This statement is wrong. Chiropractors are NOT taught this. The concept of ‘innate intellegence’ has not been taught about in any context other than as a historical foot note since the early to mid-twentieth century. Chiropractors are taught microanatomy, physiology, anatomy and neurology in exactly the same way as standard university courses would tackle these subjects.
X-rays are undertaken only in the few cases where a differential diagnosis includes that of pathology or where it is unclear from external examinations whether the extent of deterioration in a joint or structure would be likely to respond to physical therapy or require referral for surgical assessment. Radiology and radiography are taught to students over a minimum of a three year full time degree course. This is why they are appropriately qualified to use this diagnostic modality which is why they are certified in the uk to do so.

With regards to: ‘The Professional Conduct Committee has seen that treatment plans are exploitative when they are constructed around a diagnosis that leads patients to believe they are more seriously ill than they are, with the intention to promote undue dependence on chiropractic care. Some treatment plans, as shown by the evidence heard by the Professional Conduct Committee, were formulated without any adequate assessment or reassessment of patients’ needs. Going hand in hand with this approach was the routine X-ray of patients without justification. The images were used as sales tools further to pressurise patients to accept treatment..’
Please note that this quote starts with ‘the professional conduct commitee’ the very fact that this was before the professional conduct commitee clearly demonstrates that this is far from acceptable behaviour. It would be ludicrous to suggest that cases brought before the professional conduct commitee are typical of the profession. It would follow that if the examples you use to highlight the dangers of chiropractors using x-rays were a sensible arguement that (hypothetically)’due to the evidence of over 100 deaths, the GMC has decided that the G.P. Dr H.Shipman should no longer be allowed to continue in practice’ is a statement illustrating the dangers of G.P.’s being allowed to administer pharmacologic medication. This is clearly yet another weak chain of flawed logic that is not substantiated by even the facts that are supplied to illustrate it.
Any Chiropractor x-raying every new patient would be pulled before a professional conduct commitee. Chiropractors are not taught to practice in this way and do NOT practice in this way.

10 February, 2010 23:00
Blogger Le Canard Noir said…
You are overcomplicating things. My argument is simple:

Since chiropractic has little or no evidence that it offers meaningful clinical benefits, then X-raying can never be justified under chiropractic care. If X-raying cannot be clinically justified, then what chiropractors do is illegal.

On this theme…

18 Comments on Is Chiropractic X-raying Illegal?

    • Mr Brown, I presume you made your post as an alternative to dealing with the substantive issues.

  1. X rays are essential to know the line of drive,and g how much force, and what technique to use. Duff Method a way of measuring is very good taught at Sherman collage. BB’s are taped to the atlas, and then Base posterior, nasium,and A-P open mouth,and lateral x rays are taken, and then measured in an exacting precise way.This is needed.

  2. X rays are essential to know the line of drive,and how much force, and what technique to use.Sometimes a low force technique like Grostic is used. Duff Method a way of measuring is very good taught at Sherman collage. BB’s are taped to the atlas, and then Base posterior, nasium,and A-P open mouth,and lateral x rays are taken, and then measured in an exacting precise way.This is needed.

    • “It dispensed a beverage that was not quite but almost exactly unlike tea.”

      You may work out for yourself the relevance of this quote.

  3. Too early in the morning, I think I quoted inaccurately (paying the price of casuall searching the interweb instead of checking the dead-tree version))

    “it invariably delivered a cupful of liquid that was almost, but not quite, entirely unlike tea”

  4. Interesting change to the xray regulations – see Margaret McCartney’s blog: New law on irradiating well people: will it stop screening companies profiting?

    An amendment has been made to the Ionising Radiation (Medical Exposure) (Amendment) Regulations 2011.

    It comes into force on July 25th.

    It says that “At the end of regulation 3(a) (application) of the Ionising Radiation (Medical Exposure) Regulations 2000(3) after “medical diagnosis or treatment” insert “, including any exposure of an asymptomatic individual”.

  5. reasoning behind x rays
    1) suspected spinal tumors
    2)confirming severity of scolosis
    3)in the elderly to rule out osteopenia – a must before any manual therapy.
    4)to re evaluated or to diagnose degenerative conditions
    5)to identify instabilities of shoulder and other complaints
    and many more.
    basically a chiropractor wont just go in blind but can see whats wrong and why it is wrong – however this should only be done when the answers arn’t forthcoming from other clinical testing

    • These would be reasons to see a real doctor not to allow the chiro to perform manipulations given that the central claim of their profession is the existence of “spinal subluxations” and one thing we know about these, the only thing we know about these, is that chiros cannot identify them on radiographs.

      Of course, radiography lets them play doctor. They love this.

  6. Nigel – you miss the central point – given that chiropractic cannot demonstrate efficacy for many of the conditions it claims to treat and then x-raying is always going to be unethical as it cannot be used to inform how you might go about treatment.

  7. I only x-rays when suspecting fracture or pathology.

    Through discoveries made in neuro-science, biofeed-back, neurofeed-back, Heart rate variability etc, we know that the brain and nervous system regulates ALL function in the body. We also know that problems occur after some degree of loss of proper regulation or degeneration. Therefore true health care is about optimizing brain function and not merely about avoiding pain. Cardiovascular disease, hypertension, autoimmune problems don’t hurt until it’s too late. Chiropractic, which is neurologically based, helps restore balance and optimize function and regulation before there is a symptom for peak performance. That’s what prevention is all about.

  8. what a god damn crock of shit this website is!!!!! I’ve been in practice for 18 years in a blue collar agricultural region of California. I have caught so many fractures on x-rays> I’ve even caught fractures that even the hospital missed and I can “prove it ” for anyone that once to inquire. Additionally, what about all of the severe degenerative disc disease that we see on films? Does somebody think that those findings are a gimmick? Give me a break. I spit on this website.

    Who ever put this website together is a fucking idiot!

  9. If my mother’s chiropractor had taken an x-ray before treating her, he would have seen that she had severe neck pain because it was fractured in several places from a rather large malignant tumor. Instead, her medical doctor assumed it was arthritis and sent her to a chiropractor who made her condition infinitely worse. I’m obviously for x-rays prior to spinal manipulation. If the pain is from a tumor, fracture, or something else that should be treated medically or surgically, then the chiropractor could refer the patient to the proper specialist and decline treatment at their facility. That would not be unethical as le canard noir said, but rather the opposite. It would be in the patient’s best interest.

    • Nothing chiropractors do is in the patient’s bets interest. Chiropractors cannot treat or alleviate any condition. They most definately cannot do so by manipulating the neck. Chiropractors are not trained to diagnose conditions through radiography. It is a sales technique for them. The answer is not to have chiropractors using more X-rays but to not go to a chiropractor in the first place.

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