The Royal College of Vestigial Victorian Fairground-Mystic Bone Setters.

Since the invention of the semi-religious cult of chiropractic over a hundred years ago, the one thing that the believers have sought is recognition. Historically, there have been two camps within the cult: those who wanted recognition as a distinct practice within the medical community and those who wanted recognition as an alternative to mainstream medicine – a strictly alternative therapy. We hear today from the British Chiropractic Association, that their desire to be recognised as a distinct medical profession has taken another step further with the Privy Council approving the grant of a Royal Charter to the College of Chiropractors.

Chiropractic began as the invention of Daniel David Palmer. He was a magnetic healer, spiritualist and mystic who believed that he received the wisdom of chiropractic through clairvoyant messages from a dead doctor called Jim Atkinson. Palmer believed he could cure all illnesses by ‘adjusting’ peoples spines. So-called ‘subluxations’ in spines were blocking “life forces” from flowing freely causing all manner of illness in all our organs. This medically universal mystical doctrine of chiropractic is still very much alive today.

Palmer saw himself as the head of a religion comparable to Christ or Mohammad. Whether this was because he really believed this or because it was an L Ron Hubbard type trick to give his practitioners the exemptions and protections of religious belief  is not clear. What is clear, is that when he was killed by his son, who took over the reigns of power, a vast money making business was born from this charlatanism.

The history of chiropractic, in the UK as with other places, has been one of tension between gaining mainstream acceptance whilst others cling to the metaphyscial roots of D.D. Palmer. The result has been a farce: regulators and authorities only seeing the faux scientific facade of the trade whilst practitioners  routinely clinging to their strange beliefs in an ability to cure all sorts of ailments.

Many chiropractors argue for the complete divorce from their pseudoscientific roots. One recent chiropractic paper asked, “How can chiropractic become a respected mainstream profession?”

The chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant in our profession than in other healthcare professions.

Unsurprisingly for a therapeutic technique based on spooky revelations from dead doctors, the evidence base for chiropractic has failed to live up to the many claims it makes. At best a chiropractic back crack gives similar pain relief to a couple of paracetamol – but with risks of injury that chiropractors do not want you to know about. Some people may well feel a sense of euphoria after a good cracking session, but this is not indicative of any longer term effect on the course of the condition. Chiropractic appears to rely almost entirely on the fact that most back pain problems spontaneously resolve or lessen after some time. If you have been desperate for relief, and that relief has occurred some time after one or more chiropractic sessions, the temptation is to attribute the relief to the cracking.

The dangers of chiropractic are twofold: firstly, the unethical practices of ‘wellness’ chiropractic, where a chiropractor will enroll a patient into long term expensive and unnecessary  ‘treatments’ in order to maintain health and keep ‘subluxations’ at bay; and secondarily,  the risk of damage from spinal manipulation, most disturbingly during neck manipulation that can lead to stroke. Many chiropractors are keen to deny these issues.

But chiropractic in the UK has done a very good job of convincing people that the white coats, brass plaques and their self-awarded title of ‘Dr’ mean that they are a mainstream therapy. The important breakthrough was their successful lobbying of parliament to give them the Chiropractors Act 1994.  This put them on a statutory footing, with protected title, similar to other health professionals. Since then, chiropractors, their professional bodies and , unbelievably, their statutory regulator have been systematical misleading the public for two decades.

This came to light through the infamous libel case of the British Chiropractic Association vs Simon Singh. In an article in the Guardian, Singh accused the BCA of being “the respectable face of the chiropractic profession and yet it happily promotes bogus treatments”.He accused them of promoting dubious treatments for children “without a jot of evidence”.  They sued, convinced they had the evidence to support their claims that they could treat children’s ailments such as colic, asthma and ear infections – by cracking bones.

After many months of withholding their ‘plethora of evidence’, they did so, only for it to be completely demolished within hours on the pages of the BMJ. After a complex legal process, the British Chiropractic Association had to humiliatingly withdraw their action and pay Simon his costs.

What followed was shocking. Angry at the way the chiropractic profession had behaved, hundreds of complaints were made to the General Chiropractic Council, the statutory regulator, about chiropractors making bogus claims to treat children. After a lengthy and costly process, the GCC decided that the chiropractors could not be sanctioned because the regulator itself had been making these claims. Despite acknowledged systematic failures by the GCC, the  Council for Healthcare Regulatory Excellence who are charged with overseeing the GCC, failed to spot these problems in nearly two decades or do anything about it when uncovered. They appeared to be happy that the GCC had been ticking all the boxes, keeping lots of records and maintaining the appearance of a regulator, despite the fact they were quite obviously failing to protect the public from widespread misleading claims.

And so, as a reward, it looks like chiropractors are getting their own Royal College – an authoritative stamp on their supposed academic credentials. No doubt, Prince Charles views on alternative medicine and mysticism had an influence. On his web site, Charles has a FAQ to dismiss those awkward  rumours about him that he has seven boiled eggs for breakfast and supports quackery.

Does The Prince advocate untested and dangerous alternative medical therapies?

Not at all. The Prince is a keen advocate of integrated healthcare. This means taking a wider, preventative approach to healthcare by addressing the underlying social, lifestyle and environmental causes of disease. In this system patients, protected by a sound regulatory environment and the support of the National Health Service, have access not just to conventional medical treatment an proven complementary care and therapy.

Of course, his answer is nonsense, being a supporter of egregious quackeries such as homeopathy and osteopathy (a related mystical back run technique founded in similar ways and at similar times to chiropractic.)

So, like many authorities, the Privy Council has been fooled and cajoled.

In addition to this Royal seal of approval giving legitimacy to a nonsense therapy, it also undermines the credibility of the other medical Royal Colleges. Members of these colleges may wish to express their disapproval.

 


Update: 26th November

FOI requests and a bit of digging have proved some insight into what all this really means. It would appear, that for the moment, the College of Chiropractors have merely been incorporated under Royal Charter, in the same way as the Girl Guides are. They have no right, as yet, to call themselves the Royal College.

A right Royal chiro cock-up

 

249 comments for “The Royal College of Vestigial Victorian Fairground-Mystic Bone Setters.

  1. Alan Henness
    November 13, 2012 at 3:04 pm

    Odd how they’ve announced it before the Privy Council have any mention of it on their website.

  2. Colin Forster
    November 13, 2012 at 3:43 pm

    [moderated as way off topic. email me if you have an issue you want to discuss]

  3. November 13, 2012 at 4:21 pm

    This is ridiculous! Although we do in Holland have an asociation of patients favoring homeopathy, who also have the Royal seal, the Dutch Society against Quackery will ask the Dutch government to end all diplomatic relationships with the UK.

  4. November 13, 2012 at 9:12 pm

    It is absolutely ludicrous to provide chiropractic with this ‘seal of approval’. I’m sure the NZ chiropractors will soon be gloating!

    Where Tim Jay, President of the College, said, “The College of Chiropractors’ Royal Charter emphasises to the public and other health bodies that chiropractic is a healthcare profession with parity in the field of musculoskeletal health, providing a viable and recognised option for patients”, it got me wondering with whom do they have parity?

    • Tony Jay
      November 18, 2012 at 8:20 pm

      They have parity with osteopaths, sociopaths and scamopaths as well as with other chiropaths (sorry, couldn’t resist it).

  5. acleron
    November 13, 2012 at 9:26 pm

    Were the Privy Council aware that the case against Singh failed because the BCA would have to produce evidence of effectiveness of their procedures and couldn’t?

  6. November 13, 2012 at 11:00 pm

    Andy Lewis wrote: “The history of chiropractic, in the UK as with other places, has been one of tension between gaining mainstream acceptance whilst others cling to the metaphyscial roots of D.D. Palmer. The result has been a farce: regulators and authorities only seeing the faux scientific facade of the trade whilst practitioners routinely clinging to their strange beliefs in an ability to cure all sorts of ailments.”

    Very true…
    http://tinyurl.com/d74ogje

    Andy Lewis wrote: “At best a chiropractic back crack gives similar pain relief to a couple of paracetamol – but with risks of injury that chiropractors do not want you to know about.”

    It’s worth highlighting that even back pain patients are still at risk of stroke from chiropractors:

    Quote
    “Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”
    Ref: Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009)

    Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and gives the reference Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.

    Andy Lewis wrote: “The dangers of chiropractic are twofold: firstly, the unethical practices of ‘wellness’ chiropractic, where a chiropractor will enroll a patient into long term expensive and unnecessary ‘treatments’ in order to maintain health and keep ‘subluxations’ at bay; and secondarily, the risk of damage from spinal manipulation, most disturbingly during neck manipulation that can lead to stroke. Many chiropractors are keen to deny these issues.”

    It’s worth noting that there are less serious, but more common harms from chiropractic treatment which include decreased use of immunisation due to misinformation given to parents, psychological harm related to unnecessary treatment, psychological harm caused by exposure to false chiropractic beliefs about ‘subluxations’, and financial harm due to unnecessary treatment.

    Andy Lewis wrote: “But chiropractic in the UK has done a very good job of convincing people that the white coats, brass plaques and their self-awarded title of ‘Dr’ mean that they are a mainstream therapy. The important breakthrough was their successful lobbying of parliament to give them the Chiropractors Act 1994.”

    Yes, and it all seems to be about the money…

    Quote
    “In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.” Michael C. Copland-Griffiths, former Chairman of the General Chiropractic Council (European Journal of Oriental Medicine, Vol.2 No.6, 2004)
    http://tinyurl.com/c4nabne

    Andy Lewis wrote: “In addition to this Royal seal of approval giving legitimacy to a nonsense therapy, it also undermines the credibility of the other medical Royal Colleges. Members of these colleges may wish to express their disapproval.”

    Let’s hope they do. In droves.

  7. Dr Richard Rawlins
    November 14, 2012 at 11:00 am

    It will be interesting to see if they are accepted as members of the Academy of Medical Royal Colleges. If not, why not?

    If they are, scientists might as well give up.

    I am asking my own College about this. (RCS England).

    Even the physiotherapists do not have a Royal College. But the osteopaths cannot be far behind.

  8. Pam King
    November 14, 2012 at 1:02 pm

    As a long-time member of the Royal College of Nursing- a College that has had to earn the respect of the medical profession through sheer hard work and drudgery! I abhor the quackery of these people. I have a tendency to automatically distrust anything that the royal family, and specifically that idiot Charles, puts his ‘faith’ in- and to read in the comments that Physiotherapists, a wonderful, hard=working, evidence based profession- has not even received the standing that these quacks are going to get is appalling! I for one shall be complaining to my College about this.

  9. November 14, 2012 at 9:17 pm

    Oh for fuck’s sake. There is nothing else for it: we will have to set up the Royal College of Meatballology to teach the science of pastafarianism.

  10. November 14, 2012 at 9:42 pm

    I intend to write to the Royal College of Surgeons of Edinburgh and the Royal College of Ophthalmologists, of which I am a fellow, and ask them to do what they can to prevent the chiropractic college being awarded a place in the Academy of Medical Royal Colleges.

    David Amies

  11. Dr Richard Rawlins
    November 24, 2012 at 7:23 pm

    HANG ON!

    Please cite the evidence this is true.

    their web site makes no mention of it and I cannot find a reference to such a suggestion (RCC) anywhere.

    More help on this please>

    thank you.

  12. John H
    November 26, 2012 at 12:54 pm

    Sorry to post a non-contributory comment. The reference to Professor Ernst’s BMJ refutation of the quacks evidence is paywalled (The “demolition” hyperlink).

    Anybody have any ideas as to where I might find it elsewhere.

    And thank you Andy for the WDDTY spoof mags. They brightened up an otherwise remarkably dull and miserable Monday morning. Suppose I had better go back to reading Bad Pharma now that Ben has become a Big Quackery shill. Hasn’t he?

  13. Alan Henness
    November 26, 2012 at 9:12 pm

    Fortunately, all is not what it seems…

    Blogging: Zeno’s Blog » A right Royal chiro cock-up

  14. Dr Quack
    January 11, 2013 at 2:27 pm

    I have just come across this website, and I have to say it saddens me that so many people waste so much of their energy on such worthless causes.
    Regardless of what you think with the little inaccurate knowledge you clearly have of the chiropractic profession. The fact remains that chiropractic works.
    Those who commit themselves to “quackhunting” will inevitably succeed in doing nothing more than wasting their time and energy.
    The bottom line is, the VAST majority of our patients get better. And regardless of how each chiropractor chooses to practice technically, if the patient gets better and their symptoms improve, then they are happy.
    The only important person in the equation is the patient. As long as patients are improving and their musculoskeletal problems are being alleviated, then they will tell their friends and family who will also come for treatment and subsequently most likely get better.
    So try as you might with these childish, negative and sad websites to bring down professions such as mine, which only aim to get people better; unfortunately word of mouth is a powerful. It is this word of mouth which helps the profession to grow on a daily basis, and this word of mouth which is helping chiropractic to fast become a household name for leading spinal healthcare.
    As with EVERY medical branch, there are always sad cases in which people feel worse or don’t get better. But why not set up a witch hunt for all those doctors who mis-diagnose conditions? or perhaps the surgeons who fail to save lives on a daily basis? Or the amount of people who die from inappropriate drug prescriptions?
    Chiropractic remains a safe, natural alternative to all of the above. And we will continue to do a great job to serve the public and to lead non-surgical spine care.
    Your arguments are based on original tradition and archaic philosophies. I hate to spoil your fun, but we have moved on since then, and very little chiropractors still follow the old chiropractic philosophies as the were originally written. So perhaps you should update your information a little.

    All medicine began somewhere, from drilling open skulls without anaesthetic to alleviate blood on the brain to other medieval techniques. Regardless of where something began, it is where something IS and is GOING that matters. So using chiropractic’s history as an argument is redundant, and anyone with half a brain can see that.

    Good luck on your quest!

    Best Wishes,

    Dr Quack

    • Dr Richard Rawlins
      January 11, 2013 at 2:55 pm

      Of course the VAST majority of your patients get better. The VAST majority of most doctors patents get better – unless they are selectively sent intractable cases.

      Please provide evidence that the adjustment of vertebral subluxations and the release thereby of innate intellengence which affects distant somatic organs affect any pathological process – better than placebo treatment. (Pretending to do an adjustment for example).

      It is essential we have this information so can all move forward and try to identify just what this innate intellegence is.

      I can assure you we do check out failing doctors. I have been chairman of the BMA’s Audit Committee, a regional co-ordinator for the Joint Replacment Audit, and am an assessor for the GMC. Find us some poor doctors – we’ll do the rest. We will of course need evidence.

      If you are one of the chiropractors who have ‘moved on’ – why did you become a chiropractor in the first place? Why not an osteopath, physiotherapist, or doctor?

      Doctors used to use ‘heroic treatments’. No longer. We really have moved on. Leaving chiropractic behind I’m afraid. Why not join us? Your evident committment and dedication would be most welcome.

      Best wishes reciprocated.

      Richard Rawlins

      • Dr Quack
        January 11, 2013 at 3:06 pm

        I do not adjust Vertebral Sublusations. I graduated in 2009, and this is no longer part of the curriculum. So as I mentioned in my original comment, reference to old school chiropractic is now redundant.
        I would love to meet you and have a chat about what it is exactly I do with my patients. Perhaps you yourself have some musculoskeletal problems that I could treat, free of charge and with no obligations. If you’ll read the research you’ll see that the only risk associated with treatment worth mentioning is some post treatment soreness. All I ask of you is that if you indeed do feel better and perhaps see that your witch-hunt is misplaced. You write that on here.
        I do not dedicate my spare time to attacking other healthcare professions. Indeed it is within the chiorpractic code of conduct never to talk badly of other health professions. But I will say that it is a shame when one medical professional attacks another, when really Our common goal is to get people better. I decided to be a chiorpractor simply because my sister in law’s father was a consultant neurologist who lectured at the AECC in Bournemouth and he believed, knowing that I was very scientific and evidence-based in my approach, that chiorpractic would be better suited to me. I did not wish to be a physiotherpaist because they do not learn as much as chiorpractors do, and we also have a greater toolbox, and have more physical therapy interventions at our disposal. They do not learn the art of spinal manipulation and I am extremely hands on and practical and love to learn new and complex skills. These reasons coupled with a strong desire to simply get people better was my reason for choosing chiorpractic. I was actually also offered a place at the British School of OSteopathy, but I declined after visiting the Welsh Institute and seeing the fantastic programme they offered.

        Best Wishes

        • Badly Shaved Monkey
          January 11, 2013 at 6:07 pm

          I do not adjust Vertebral Sublusations.

          What do you adjust?

          What evidence do you have that your adjustments produce better outcomes than any othe standard care?

          Do you adjust the cervical spine?

        • Andy Lewis
          January 11, 2013 at 6:08 pm

          It would be quite appalling to think that all that money and time in training was to study something that was no more than an elaborate placebo based on an old vitalistic worldview, wouldn’t it?

        • Dr Richard Rawlins
          January 11, 2013 at 6:19 pm

          Thank you for that. Whoever you are.

          Why did you not become a physio, or doctor given your evident vocation. And why go to osteopathy in the first place?

          If you don’t adjust subluxations, just what are you doing that a physio does not/

          No one is attacking your ‘profession’.

          Many of us have a very hard time understanding just what you are up to.

          You should come to an academic medical meeting and see how we have a go at each other!. It’s called ‘scientific peer review.’

          Answers to my inquiries would help.

          I am pleased that your code of conduct forbids ‘attacking’ another profession.

          I was interested that physios do not learn as much as chiropractors. Incoherent or what/

          And how do you know?

          Let us face it. You like alternatives to regular orthodox therapies. Fair enough. I just hopw you get properly informed consent from your patients.

        • January 11, 2013 at 11:44 pm

          Dr Quack said, “reference to old school chiropractic is now redundant.”

          It isn’t redundant to refer to old school chiropractic as long as chiropractors are doing old school chiropractic and they are. Both the chiros I saw a few years ago were full of it. I hasten to add that I only saw them because they haranguing people in shopping centres like carwash hustlers. What sort of “profession” does that, for pity sake?

          Unfortunately, an ‘old school’ chiro treated my teenage niece for chronic pain. He diagnosed a muscular skeletal problem, talked about ‘subluxations’, which he ‘adjusted’ and spouted some nonsense to the effect that he could feel the problem leaving and it would just need a few more sessions. On about session 8 he said that unfortunately there’d been a regression and he could feel the problem had returned and it would, of course, need a few more sessions.

          The treatment was relaxing but at no time was her pain relieved. This isn’t surprising as it turned out that her pain had nothing to do with so-called subluxations in the spine. It wasn’t even a muscular-skeletal problem but an extremely rare problem with her biliary duct.

          “It is this word of mouth which helps the profession to grow on a daily basis, and this word of mouth which is helping chiropractic to fast become a household name for leading spinal healthcare.”

          Dream on. In the last few years many more people have become aware that chiropractic is quackery.

  15. Dr Quack
    January 11, 2013 at 3:25 pm

    By the way, I am aware that I regularly mis-spell CHIROPRACTIC, I type too quickly and ironically that word always gets me! I should copy and paste into word and run a spell check, but you get my drift I’m sure.
    I hope that the Bad-Spelling-Busters don’t get me too!

    • Dr Richard Rawlins
      January 11, 2013 at 6:21 pm

      Subluxed letters benefit from adjustment!

      • Dr Quack
        January 11, 2013 at 6:37 pm

        Dr Rawlins that’s actually very funny lol :)

  16. Dr Quack
    January 11, 2013 at 6:22 pm

    To answer all of your comments:

    I adjust facet joints which have decreased range of motion. I call this spinal dysfunction personally. My goal is to improve the range of motion, the joint’s neutral zone (in biomechanics). Yes I adjust the cervical spine; may I ask if that is something you know much about? Physiotherapists also train post-graduate to give “Grade 5″ adjustments, which we chiropractors call manipulation. Never have I had a patient who has experienced anything worse than a little soreness followed by much relief having had this done.
    Andy, with regards to your comment, the money and time was well spent. I know have a career which entails travelling to work each day and treating patients, who are more like friends, using nothing but my hands, clearly avoiding the side effects of dangerous drugs or surgery. They come in in pain, they leave feeling relief. I use Orthopaedic and Neurological examination (like an orthopaedic surgeon, or neurosurgeon) to help dictate what I do, and I keep detailed notes of every encounter. I also give advice on rehab, exercises, posture, lifestyle, diet, and stress reduction.
    My patients write kind testimonials without my requesting them and they are posted on local websites. There is NOTHING magical, nothing mystical and nothing complicated about what I do. It’s highly rewarding and I love it. I’m basically a mechanic for the body, parts stop moving properly, things tighten up, joint get stiff, and muscles get tight. So I just find the parts which are a little stuck, and give them a little nudge and the patient feels better.

    No Rocket Science involved, and certainly not an “elaborate placebo”. It’s pure mechanics. We are machines with moving parts, as we get older, or misuse our bodies, these parts become worn, stiff, and tight (everything tightens up as you get older I’m sure you’ll have noticed). I just help to loosen things up and allow my patients to stay as mobile as possible for as long as possible.

    Any other questions? I love answering them!

    Feel free to ask anything you like, you clearly need to learn a little more about what you’re talking about

    :)

    • Dr Richard Rawlins
      January 12, 2013 at 12:41 am

      Ah!

      So you are a physiotherapist, albeit un-qualified as such. That I understand.And your real name is?

      And tell me more about these facet joints. Apart from medical school, I was a lecturer in Anatomy and have dissected them on a number of occasions. Also as an orthopaedic surgeon I have operated on them.Cervico-occipital to sacral.

      I found I was quite unable to move them significanty without using a bone lever at direct open operation, or without using an osteotome to undercut a facet. And I’ve never seen a subluxation. have you? (Dislocations, yes, but that is not what chiropractors describe).

      I’m intrigued to know how you manage.

      Oh and by the way – there is no such such thing as an “orthopaedic examination” except for one done by an orthopaedic surgeon. Which you are not.

      If your school told you they were teaching you how to conduct an “orthopaedic examination” they were misleading you. I should ask for my money back if I were you!

      And if you had taken the trouble to become an orthopaedic surgeon, you would be able to offer your patients an option: surgery or not as the case demands. As it is you clearly offer love. I am sure your patients appreciate that.

      I work in a team. I offer options. surgey,manipulation (by a physiotherapist). My patients do not want their innate intellegence freed up.

      And, as you know perfectly well, there is no such institution as the Royal College of Chiropractors.

      I do wish you’d found your way into an orthodox profession. You clearly have much to offer. It’s never too late!

      • January 12, 2013 at 1:27 am

        Dr Richard Rawlins said:

        I found I was quite unable to move them significanty without using a bone lever at direct open operation, or without using an osteotome to undercut a facet. And I’ve never seen a subluxation. have you?

        Ah! But chiros have magic hands!

        • Dr Richard Rawlins
          January 12, 2013 at 8:34 am

          I claim to be the only qualified magician in this discussion!

          Richard Rawlins
          AKA Professor Riccardo
          Member of The Magic Circle

          On a serious note: Alan has it on the button. Magic.Paul Caster (born Custer) was a ‘magnetic healer’ in the US Mid-West who used mesmerism.Of his students, A.T. Still founded Osteopathy (somatic disease can be helped by manipulation of bones and releasing blockages in the blood supply to the distant part). D.D. Palmer, under the guidance so he said of his god, founded Chiropractic (adjustment of vertebral subluxations releases innate intellegence and unblocs the free flow of vital neural energies which thereby benefits the distant part).

          Spinal manipulation obviously helps folks with stiff spines. That’s what physiotherapists do. But that is not what Chiropractic is. Chiropractic is a “primary healthcare profession”. Chiropractors practice medicine. Many claim they are doctors. In the US you cannot practice medicine without a licence – so they make sure they have one! But not MD degrees. In the UK anyone can practice medicine without a licence – just not in the NHS, nor can they claim to be a “Registered medical practitioner” unless they are. Any one can style them selves as ‘Doctor’ – though why they would do so unless they want to mislead patients I do not know.

          But misdirection, sleight of mind, and creation of illusions is what magicians do. Most of us are honest enough to fess up and admit it. You must judge the integrity, intellectual honesty and probity of chiropractors for yourself.

          (BTY I am not a ‘retired orthopaedic surgeon’ though I am retired from clinical practice. I still consult and offer my services to the BMA, GMC, Royal College of Surgeons, and the Courts and legal profession as an expert medical witness. I am still registered by the GMC!)

          • John H
            January 12, 2013 at 11:12 am

            Dr R R

            Apologies for the “retired” canard. I either misunderstood or misinterpreted something from the TATTnes discussion thread. Perhaps “retired from clinical practice” led me astray. Still, you do seem to have a fleeting familiarity with the skeleton.

            Any chance Professor Riccardo can magic me up a new lumbar spine?

      • Dr Quack
        January 12, 2013 at 10:42 am

        Dr Rawlins,

        At which point and why have you determined that I’m a physiotherapist? Do you lump everyone who does not cut people with scalpels into one box to make life easier for you? We are distinct professions, there is considerable overlap in what we do, but our education focuses a lot more on the spine and manipulation of its numerous articulations. I would be surprised to hear a physiotherapist say that they could manipulate the spine as proficiently as a chiropractor, with their undergraduate training alone.

        Your comment:

        “I found I was quite unable to move them significanty without using a bone lever at direct open operation, or without using an osteotome to undercut a facet. And I’ve never seen a subluxation. have you? (Dislocations, yes, but that is not what chiropractors describe).”

        Firstly, I find this comment hard to respond to. Mainly because it lacks some vital information. Why was this patient having surgery? What was the diagnosis? The age and gender? any degenerative changes? ankylosis perhaps?

        You left out the key information there. Get back to me and I will tell you whether or not I could have moved it, but I’m guessing after the mess you made with your “bone lever and osteotome” there’d certainly be no hope of helping afterwards!

        Also your comment “I’ve never seen a subluxation, have you?” is a strange one because subluxations aren’t things that chiropractors claim to see, as such, they “claim” to feel them with their hands. So let’s leave that one there.

        I do not wish to argue with you, especially as you are being pedantic, and such arguments I left behind in the school playground a long time ago. I prefer to stick to the bigger picture usually. However, I am polite and will address your points. By Orthopaedic examination, I mean there is a section of my physical examination, which entails performing orthopaedic tests. Orthopaedic tests are orthopaedic tests, whether an orthopaedic surgeon performs them or a chiropractor. They could be taught to a monkey my friend. One does not need to study medicine to learn how to apply them, they are simple.

        Secondly, I used to want to be a doctor. When I was 11 that was my original dream. My primary school teacher brought in lamb’s hearts and we dissected them with kitchen knives! I was sold! I wanted to follow in my brother’s footsteps, who was at the time a newly qualified doctor (now a consultant in his field).

        However on reaching the age of 16, we had to find work experience placements. I naturally chose to follow a surgeon who was my father’s friend, and also on a separate occasion a GP. My dreams were somewhat shattered when I followed the surgeon around hospital on ward rounds, and watched him in theatre operating. It lacked the kind of patient-doctor interaction I had imagined. Watching the GP too, rapidly prescribing medications for everyone, hardly touching a single patient, more concerned with the time than anything else was enough to put me off. I was very upset, and also lost, as now I had no direction.

        I found chiropractic thanks to a friend’s recommendation. She had been successfully treated by one, and it sounded fascinating. I had been increasingly interested in exercise and health as a young twenty-something student, and so I liked the sound of giving exercises to patients and lifestyle modification advice. I did some research and found (on a non-chiropractic, non-biased website) that chiropractic seemed to tick all the boxes for me. Spending plenty of time with the patient, being the one in charge of meeting the patient, doing the case history, the examination, taking x rays if necessary, reporting all the findings back to the patient, devising a plan of management and also implementing it! Sounded great to me! (and it is). I got to be with the patient at every stage of their care, as opposed to the patient being passed around the NHS from one practitioner to the next, and often feeling completely in the dark throughout the process, as I witnessed in my work experience.

        I assure you Dr Rawlins, being an orthopaedic surgeon, was the least most appealing thing to me, and it still is, although it would have its perks. You may then find it hard to stand on your pedestal and wag your finger so pompously. Maybe I should study JUST to give my arguments more credibility in your eyes? Would you agree? Then again I have orthopaedic surgeons who are my patients, as well as GPs, physiotherapists (I work with 3) and Osteopaths. The irony here is that this is just one man’s opinion, and he is entitled to it. But sadly it does not represent your entire profession. I have probably treated a few of your colleagues.

        Even more hilarious was your comment that you offer an “option: surgery or not as the case demands”. Wow, what a vast toolbox! Anything else you offer? Must you cut everyone open to make them feel better? Oh I’m sorry you did say, you refer them to a physiotherapist for manipulation. So if you can’t cut something, then you are lost it would seem… how limited your toolbox was. I’m sure you saved countless lives in these extreme situations. I just see your everyday Joe blogs and Mrs Smith. But they are ecstatic to get some quality of life back, and that’s enough for me.

        Some of you may have been tainted by chiropractic, probably personally, such as SKEPTICAT above, who had the unfortunate incident with his daughter, and is now naturally jaded. I’m sure if the chiropractor had been the only one to have successfully diagnosed the problem, and referred accordingly, he or she would have been hailed. I know I’ve been the only one to notice a few conditions before, much to the delight of my patients and the astonishment (and embarrassment) of their doctors. It never ceases to amaze me the power of a traumatic event or bad experience – we can instantly generalise and assume that everyone is the same, even though logically we know the laws of probability are against us.

        Finally in reference to this comment. Do not wish for me that I had found myself into an orthodox profession. I’m happy where I am. I do not have any problem with mainstream medicine. In fact I work alongside physios and GPs and regularly send and receive referrals to and from surgeons such as you. They respect what I do, and realise that it works. I have the best of both worlds, and I do it all with my “magic hands”

        Anyway. I know this argument can go on and on and on so it’s important to know when to stop. My only aim is to offer any potential reader some food for thought and perhaps another side to this otherwise extremely biased discussion. Luckily any reader with common sense can see that, but it’s still good to have the perspective.

        On to the next comment….

        • Andy Lewis
          January 12, 2013 at 11:59 am

          Dear Dr Quack,

          How do you know you are not as deluded about your justifications of chiropractic as subluxtion-based chiropractors?

        • Dr Richard Rawlins
          January 12, 2013 at 12:37 pm

          I wish I knew your name. However,thank you very much for your posting from which we can learn much.

          I know what a physiotherapist does, and that is what you do – with additional manipulation. What other differences are there?

          My comments about facet joints referred to numerous patients for numerous reasons. Facet joints are very hard to move without considerable force. e.g. in a major accident. It might be they get stiff capsules which benefit from manipulation (and heat, and excercise)but that does not ammount to any form of ‘adjustment. It just doesn’t. Please move on. I asked you if you had seen a facet joint (in a living patient). Apparently not.

          We just do not recognise the term ‘orthopaedic examination.’ There are a variety of physical examination techniques, but none used exclusively by orthopaedic surgeons. A ‘neurological examination’ specifies the neurological system. but there is not a ‘orthopaedic system’ nor ‘orthopaedic tests’ – so the terms you use are simply not receognised by the orthodox community. I cannot of course speak for alternative practitioners. You will have your alternative views of life, the universe and everything. I am sure we all agree the answer is 42.

          I always told my students that surgery could be carried out by any well trained orang-utan. But they had to be well trained, and versed in the scientific method!

          And now to the rub of it. I am sorry your ambition to become a doctor like your brother was not fullfilled. As you correctly point out, there are many faults with some medical practitioners and we could have done with your particular insights and dedication. But although I get the sense that you scouted around to find a job in the healthcare field which would provide satisfaction, I remain unclear why you settled on chiropractic. The elements of practice you describe are not exclusive to chiropractic. What is the USP of chiropractic? Metaphysical, magical, imaginative. Mot manipulation – that can be done by other practitioners (as the Government review on back pain pointed out – citing ostepaths, physios and doctors).

          So, just what do you imagine you are doing when you move all this ‘innate’ about? Or has that gone the way of ‘subluxations’? If so, what’s left?

          You seem to misunderstand the nature of surgery. We do not want to operate. We only do so when there is no reasonable alternative. (Which fortunately is often enough to provide us with a good living). If we find any practitioner operating when not necessary, we disclipine them. Even strike them off. We are very tough on unethical behaviour.

          The decision is more important than the incision. Deciding whether to operate (and when, how etc.) is more important than the doing of it. Good surgeons know when to say “no.”

          Finally, I note your claim you have the best of “both worlds”.From my perspective, there is only “one world” – and we live in it. Cartesian dualism, superstition, vitalism, macriapheric medicine are now the alternative to modern rational scientific evidence-based medicine.

          May the wu be with you, and your chakras ever be aligned.

          Best wishes,

          Your new friend who cares about you,

          Richard

          • Dr Quack
            January 12, 2013 at 4:57 pm

            Richard, my new friend…

            I actually like you a lot. You’re very witty and funny, and we can assume you have half a brain being a surgeon.

            I’m sorry to disappoint you with me answer, but I didn’t care whether I became a chiropractor or an osteopath. I applied for both, got an interview for both, and got accepted for both. The reason I chose chiropractic was more logistics, living near the college, already having a life and a job that would support my studies.

            All I cared about was being in a healthcare profession which ticked all the boxes. Those boxes were – Getting patients better without drugs or surgery, being in charge of all aspects of the care at all stages, having a good thorough grounding in all the necessary medical sciences, and of course more lifestyle related criterion such as self-employment status and good quality of life.

            You said you wished I’d seen a facet joint in a living patient. Sadly I have not had the privilege, I’ve only dissected cadavers while studying my first degree – Human Anatomy (or anatomical sciences), alongside the medical and dentistry students at Cardiff University where I studied before I did chiropractic.

            By the way, not once did I mention innate intelligence. Nor do I believe I affect that. Maybe I do, if it exists, but it clearly doesn’t affect my practice whether I consider it or not. My patients get better, and I haven’t mentioned the word innate intelligence in the 3 and half years since graduating! So it makes no difference to me (or my patients clearly). You seem quite obsessed with these age-old chiropractic beliefs. In fact you probably know more about them than I do. It is possible to practice chiropractic without mentioning them throughout your career, if you want to.

            I think one of the major questions you have is what makes me different to a physiotherapist?
            I find this easier to answer than the classic “What’s the difference between a chiropractor and an osteopath?”

            Well firstly we train for longer, our undergraduate education is to Masters level and a yearlonger. We are required to learn more, study more hours, and dedicate the vast majority of our practical skills training to palpation and manipulation of the spine.

            Our education gears us up to be primary care practitioners. To be able to formulate a working diagnosis and to devise a plan of management and to implement it. We have more accountability for what we do. We do not get told by GPs “Mrs Smith has mechanical low back pain, please provide some relief and help her strengthen her back so she can return to work” blah blah blah.
            That is a part of what we do. But I will say, and upset a few physios, that our education encompasses theirs, and adds a whole lot more. The fact of the matter is that we have a huge variety of techniques to relieve pain and improve function in the spine. We dedicate countless hours to the study of biomechanics to know the angulation of each joint, how each one moves individually and as part of a greater system. We spend years refining our extremely fast ability to manipulative, to deliver the cornerstone “High Velocity Low Amplitude manipulative adjustment” to the joint at exactly the right speed and vector to cause instantaneous improvement in joint function.
            I’m sorry but physios just don’t train as much as we do, and they don’t manipulate as well or as confidently as we do. They have far fewer adjustments taught to them even at postgraduate level, and they don’t spend long enough honing these skills. They are trained and groomed to answer to the medial profession. We are doctors of chiropractic. We deserve this title and I use it proudly, though not misleadingly which is the key. A physiotherapist is a musculoskeletal generalist. We specialise in treating the spine. So personally if I had a spine problem I’d want to see the guy who had trained the most in treating the spine. Wouldn’t you?? Is it just me or would you agree that this is common sense.

            Remember I work alongside physiotherapists at a multidisciplinary clinic in London. There our physios often refer their own patients to the chiropractic team for manipulation of joints that they themselves cannot release. They gladly admit this without feeling as though their egos are permanently damaged. They are professional and know their limits, as do I. I don’t treat everything that walks in to the clinic. I refer many people to Orthopods, neurologists, spinal surgeons and so forth.

            The key is to know your limits and (as you said, and I often say myself) to know when to say no. A good chiropractor will know when to say, “I can’t treat this”. The word chiropractor can be substituted with a practitioner of any healthcare branch.

            As professionals we all have egos, and the funny thing is that usually, inter-professional arguments about the validity of one treatment over another stem from ego-battles. Even you yourself started one post with a listing of your qualifications and esteemed job roles and privileges. It’s always about proving your worth and obtaining validation from others.

            I’m not trying to boost my ego. I’m just passionate about what I do. I enjoy what I do. It’s not rocket science. It gets people better. It makes me happy. I practice honestly and ethically. I sleep well and without guilt each night.

            you challenge using your status as a medical doctor and your experience in various roles to intimidate me but you fail. I could study medicine in 4 years with a graduate access course at Kings College London, or one of many other UK courses. I could do a PhD if I wanted to. All these things for what? to gain more credibility to be able to waffle my way through and win arguments about philosophy against other professionals???
            What a waste of energy. I don’t need any of it. Because I’m logical, rational, open minded and passionate. I as many people am also able to see through the venom spewed on these websites as nothing more than thinly veiled jealousy and a send of threat. If Chiropractic didn’t threaten people in the medical community in any way, they wouldn’t feel the need to try to bring it down.

            That is why you won’t succeed. Because your side of the fight is based on psychological feelings of inadequacy. Ours is fought from the side that what we do WORKS and we know it does and we are passionate about it. You need only ask the important person in this whole debate.

            THE PATIENT.

          • Andy Lewis
            January 12, 2013 at 6:30 pm

            Can I ask how many years of study it takes for astrology to be true?

          • Dr Quack quack
            January 12, 2013 at 7:24 pm

            Can you say something intelligent worthy of the effort of a reply, Andy?

          • Dr Richard Rawlins
            January 13, 2013 at 11:29 am

            And your name is?

          • Andy Lewis
            January 13, 2013 at 12:47 am

            Just because someone believes they have studied hard, does not mean that what they study is true.

            I hope you understand this point.

  17. John H
    January 11, 2013 at 7:09 pm

    Dear Dr Quack.

    He certainly does not require my support in any way shape or form but I think you will find that Dr R R is a retired orthopaedic surgeon ( apologies if I have got this wrong).

    He will more likely hide his light under a bushel as it is perhaps not strictly relevant to the questions he has raised.

    He probably has a slightly more than passing familiarity with the cervical spine (and very likely the rest of it as well, although that is pure speculation on my part). He may even have some vague knowledge about all the other bones as well.

    So. Do I take my eight fractured vertebrae to an orthopaedic surgeon or to a chiropractor (easy enough to spell if you laugh at it long enough) who seems to eschew the basis of chiropractic.

    And what exactly is so natural about all tha X-rays back crackers dish out.

    • Dr Quack
      January 11, 2013 at 8:33 pm

      Hi John H,

      Thanks for joining the discussion, great to have more opinions and input on board. With regards to my comment regarding cervical manipulation, I wasn’t actually referring to anything Dr Rawlins was saying it was an answer to Badly Shaved Monkey’s comment:

      Badly Shaved Monkey January 11, 2013 at 6:07 pm
      I do not adjust Vertebral Subluxations.

      What do you adjust?

      What evidence do you have that your adjustments produce better outcomes than any othe standard care?

      Do you adjust the cervical spine?

      And with regards to your comment:

      So. Do I take my eight fractured vertebrae to an orthopaedic surgeon or to a chiropractor (easy enough to spell if you laugh at it long enough) who seems to eschew the basis of chiropractic.

      Absolutely take it to the Orthopaedic expert of course. The last thing you should have is your spine manipulated if you have fractured vertebrae. Of course as we are trained in taking a full and thorough case history, doing a physical examination, and (as it would be QUITE obvious to any physical therapist with a basic understanding of orthopaedics), if you did seem to have fractured vertebrae, we would probably decide to take an x-ray to have a look. Following this I would personally either send you immediately to A&E if it was an acute and dangerous fracture or via your GP to an Orthopaedic consultant if your fractures were stable.

      I’m getting a little lost in all these questions and comments, but I’m attempting to address them all, bare with me.

      The risk of Arterial dissection, following manipulation has been found to be negligible. Are you aware of the Bone and joint Decade task force on neck pain? And it’s findings? It was published in spine, here is one of many links:

      http://journals.lww.com/spinejournal/Fulltext/2008/02151/The_Bone_and_Joint_Decade_2000_2010_Task_Force_on.4.aspx

      Here is the answer to your question regarding vertebrobasilar stroke, to make it easier for you:

      “There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.”

      What this means is that the previous “beliefs” regarding chiropractic causing stroke were based on misinterpreted information.

      I believe the risk of stroke from cervical manipulation is around 1 in 3 million. I’d more likely win the lottery I think, and much prefer that too.

      No strokes in my clinic so far. Maybe it’s because I’m also qualified to do a full cardiovascular risk factor screen, measure blood pressure and pulse rate and rhythm as well as palpate the carotid arteries, check for Bruit, listen to heart and lung sounds, palpate the heart beat itself and take Chest X-rays to look for an enlarged heart shadow.

      Do you think we manipulate every neck we see? Lol

      Sadly we don’t I’m afraid, so no dangerous chiropractic going on anywhere I think you’ll find. We have WAAAAAAY to many screens that prevent us from manipulating “risky fragile necks”. If someone is likely to suffer a stroke for whatever reason coinicidentally. We wouldn’t manipulate anyway, we would just massage and mobilize. A lot like a physio! Funny that hey! ;-)

      Unfortunately regardless of your limited knowledge, or the plentiful knowledge of Dr RR, NONE of you clearly have a clue about what you’re talking about, because none of you are chiropractors and none of you have any REAL insight. You don’t know what educational levels and standards there are, you don’t know what is in the chiropractic syllabus (one study compared it to the medical undergraduate education… guess what… almost identical!), and none of you have read the code of practice and standards of proficiency (available on the General Chiropractic Council’s Website.

      Have a read… you might be surprised how thorough and diligent we are actually.
      Perhaps the reason why we are now proud to be members of the ROYAL COLLEGE OF CHIROPRACTORS.

      I’ve never been happier to practice my incredible profession.

      Any more questions? This is fun!

      • January 11, 2013 at 9:42 pm

        Why do you call it the Royal College of Chiropractors?

          • January 12, 2013 at 1:09 pm

            I see you’ve made the same basic mistake that many other chiros have made.

            The College of Chiropractors are not entitled to call themselves the Royal anything; they simply now have a Royal Charter of Incorporation – it hands a lot of power over to the Privy Council and simply puts them on a par with the likes of:

            London Homoeopathic Hospital
            The Worshipful Company of Launderers
            The Worshipful Company of International Bankers
            Worshipful Company of Builders’ Merchants
            Society for Promoting Christian Knowledge
            Worshipful Company of Basketmakers
            The Worshipful Company of Marketors
            Basildon Borough
            Girl Guides Association
            The Worshipful Company of Tax Advisers

            No offence to members of these esteemed organisations.

          • Badly Shaved Monkey
            January 13, 2013 at 3:37 pm

            Andy, this is quite important;

            There seems to be a post missing here from Dr Quack. Has it been lost by the blog software?

            I’m fairly sure it contained the following words.

            “Yes, Alan, you are quite right. There is no such thing as a ‘Royal College of Chiropractors’ all we have is a charter that sets us on the same footing as some basketmakers.”

            Do be a good chap and look for it. I would not want Dr Quack to appear ungracious and as if he has blithely ignored the correction Alan has made.

        • Colin Forster
          January 13, 2013 at 9:10 pm

          Alan, are you saying that the whole premise of the title of this blog post, “Royal College of Vestigial Victorian…” is false?

          • January 13, 2013 at 11:57 pm

            It took a bit of digging to fully understand the situation – Andy was no doubt going on what many chiros seemed to be claiming, but all the College of Chiropractors has been granted is a Royal Charter of Incorporation and that does not entitle them to call themselves the Royal College of Back-crackers Anonymous or anything else. No doubt proclamations such as:

            This new award for the College of Chiropractors puts it on a similar footing to the other Royal Colleges in medicine and dentistry. (Source)

            by Matthew Bennett, an officer of the College and Vice-President of the British Chiropractic Association, had a lot to do with the ‘misunderstanding’ that surrounded the announcement.

            For further details, please see my blog post: A right Royal chiro cock-up.

      • John H
        January 11, 2013 at 11:00 pm

        Well at least this conversation ain’t going down the Iqbal/Mr A C Fontaine route.

        As my idea of science is hitting rocks with a hammer (i know – a bit like the monkeys at the start of 2001) i am sure there are plenty of contributors who can better respond to the above.

        Just one point. The chiropractic stand in the shopping mall at Walton-on-Thames offered me backquackery with no further discussion. That would have been another three superior endplate collapses.

        You sound vaguely human – not all of your industry shares that quality.

        Where do you stand on things like infant colic, ear ache, bed wetting etc.

        • Dr Quack
          January 12, 2013 at 12:48 pm

          LOL I am almost flattered John! I THINK you said something nice? Yes I am vaguely human, part human, part duck (hence my name). Sorry I’m just joining in with the whole ridiculousness of the site and its contributors, I lied about my duck ancestry.

          I cannot STAND the stands at shopping centres. I abhor them, and agree with someone else above who said they look tacky and cheap. Personally if your business isn’t doing well enough on it’s own to bring in new patients, then you need to change your practice style and perhaps take a course in patient communication to boost referrals. I agree with you wholeheartedly that they are awful. And this would be an example in my opinion of unethical practice, to offer someone treatment without the necessary pre-screening procedures. I can assure you if you came to see me, you would not be manipulated or at risk.

          This subject brings up the KEY fundamental problem here. This problem is not exclusive to chiropractic, but is present in mainstream medicine and all healthcare where there is MONEY involved. This is the difficult issue of ethics as a whole.

          What needs to be addressed is UNETHICAL practice.

          We shouldn’t aim to bring down a whole profession. We need to address this issue of unethical practice. How do we do this? What is unethical practice? how do you ensure that people practice ANY field ethically. We need to more closely and tightly regulate the profession in my opinion to stamp out the few who spoil it for the many of us who genuinely ARE ethical, honest and patient-centred.
          Unfortunately some people become blinded by money and financial gain and the priority becomes generating wealth instead of improving people’s lives.

          This is a hard issue to tackle, but it’s one I personally wish to support as fiercely as I can. Maybe then websites like this will cease to exist.

          P.s. I don’t treat the conditions you mentioned, but I know many who do very successfully, we just need more research which is in progress so watch this space. Remember the World was flat once. Just saying ;-)

      • January 13, 2013 at 1:20 pm

        Dr Quack wrote: “The risk of Arterial dissection, following manipulation has been found to be negligible. Are you aware of the Bone and joint Decade task force on neck pain? And it’s findings?”

        I am, but I don’t think you are. That Cassidy et al study – that’s been so widely touted by chiropractors – was fatally flawed. See: http://tinyurl.com/bp7dkn3

    • Dr Quack
      January 12, 2013 at 10:42 am

      Just realised I posted a new comment beneath yours as opposed to clicking reply on your comment, so making sure you get my reply below! :-)

  18. John H
    January 11, 2013 at 7:33 pm

    I forgot to ask my second question (and I note that that last post was exposed to a nasty case of Muphry’s Law).

    If the only risk from backcrackery is some post treatment soreness perhaps you could elaborate on stroke deaths caused by vertebral arterial dissection as a direct result of cervical backcrackery? Hardly seems minor.

    • Dr Quack
      January 12, 2013 at 11:45 am

      see my answer above relating to the risk of stroke.

  19. Badly Shaved Monkey
    January 12, 2013 at 8:09 am

    I adjust facet joints which have decreased range of motion. I call this spinal dysfunction personally.

    I have met a senior figure from the AECC and he repeated a similar cant. Unfortunately it was at a restaurant with loud music and I was unable to ask the relevant follow-up questions, so I’ll ask you.

    How is your “spinal dysfunction” located in facet joints different from the chiropractic “subluxation”?

    How do you demonstrate, objectively and reproducibly, that a problem exists with facet joints?
    How is it demonstrated that a facet joint problem is causally connected to any problem of the patient?
    How is it demonstrated that any manipulation made by you alters those facet joints?
    Do you restrict your activities to patients with back or neck pain? Do you treat people with the intention of helping non-musculoskeletal problems?

    I look forward to your answers.

    • Dr Quack
      January 12, 2013 at 11:44 am

      Such a shame the restaurant was so loud, perhaps you could have gone outside or asked for contact details to get in touch and ask him the same questions? I’m sure he’d have been delighted to answer, as am I.

      Either way:

      How is your “spinal dysfunction” located in facet joints different from the chiropractic “subluxation”?

      A name, a name, a name. I guess the main difference is that mine makes more sense to me personally. I see a joint in the spine as having a normal function, to move. If I feel a joint is not moving within a normal range of motion, it has impaired function, or “dysfunction”. I personally don’t use the term subluxation, because it already has a medical definition, which can cause confusion. But I guess we could call it a banana, and that I adjust bananas, and that patient’s have banana’s ion their spines. Who cares? if I adjust a banana and the patient feels better, end of story. Does naming everything make one more comfortable? Again it seems like a question of needing to label everything accurately to make the world around us less scary.

      How do you demonstrate, objectively and reproducibly, that a problem exists with facet joints?
      Inter-examiner reliability has been shown to be poor when performing orthopaedic tests, or palpating the spine and muscles (or any other body part). However INTRAexaminer reliability is good. The great news is that I will most likely always be the one who examines the patient at each subsequent visit, so I can see the improvement objectively. We use orthopaedic tests to stress the facet joints (such as axial compression with extension, maximal foraminal compression tests, kemps etc), and we check active and passive range of motion. We also palpate the spine as it moves, using our fingertips along the articular pillars of the spine to assess the end-feel of a joint in motion. Owing to the cartilage in a synovial joint and all the surrounding tissues. With lots of practice, one can get a feel for a healthy springy joint. Whereas a banana… sorry I mean a dysfunctional joint will have a hard wooden end-feel, and offers resistance to the highly sensitive fingertips. This is the art of chiropractic. It takes years to develop this sense of touch. As we palpate the spine, we can tell the patient without their direction which joint is causing the problem, because we can feel the restriction. The patient will confirm the correct location of this dysfunction (much to their own amazement sometimes). Call it Magic if you want.

      How is it demonstrated that a facet joint problem is causally connected to any problem of the patient?
      I find this question a little odd. If we press on something and the patient says “Ouch that’s the area and that’s what hurts every day!” Then I guess we have our answer. As that is the purpose of an orthopaedic test, to stress a certain tissue, and thus give us the source of the problem.

      How is it demonstrated that any manipulation made by you alters those facet joints?
      We can test pre and post manipulation of course. We locate the facet joint (if indeed it is the facet joint we need to treat, and not a muscle etc., but we can stay with facet joints for a while), then we decide how best to manipulate it, taking into consideration numerous variable such as the patient’s body shape, the region of the spine, the age and gender of the patient, their muscle tone, the build of the chiropractor, any co-existing lesions (such as a hip replacement for lumbar spine manipulation, we would avoid using the femur as a lever in this case, for example) and other factors, and then apply a gentle high-velocity, low-amplitude impulse to the specific joint in question. Then we re-test, is it as stiff? Do the muscles feel more relaxed? Is the patient more mobile? Are the orthopaedic tests now less painful or restricted? And therein lies our answer.

      Do you restrict your activities to patients with back or neck pain? Do you treat people with the intention of helping non-musculoskeletal problems?
      I do not restrict my activities to neck and back pain. I treat all kinds of joint problems. I like to treat headaches, knee pain, tennis elbow, wrist pain, muscular strains, hip problems, posture problems, degenerative joint disease, and many other ailments.

      I do not claim to cure organ-related pathology, though I cannot deny that many patients have told me as an aside that now their other problems have improved. Perhaps there is a link? Perhaps not? Perhaps I just improved their stress levels, now that their pain has gone they are relaxed. I am fascinated by this field, but know little about it. I know that Psychoneuroimmunology is growing rapidly and gaining much kudos nowadays. But I’m just a mechanic for the body. So I will leave that stuff to them. Bring me your dodgy knees, or your wonky pelvis, or your slumped desk posture and I’ll sort it out. I’ll leave the more complicated stuff to the researchers, who are at the forefront of this field and are better qualified to answer you about “somatovisceral and viscerosomatic” associations.

  20. Dr bored of this
    January 12, 2013 at 12:14 pm

    I can not believe how much time you are wasting abusing another profession..you seem to easily dismiss a profession that practices a technique that the NICE guidelines recognise as an effective approach to lower back pain. You readily refer to physiotherapists whom claim they can perform spinal manipulative therapy which is studied at a post-graduate level over a weekend course an yet Chiropractors and Osteopaths spend 5 years studying this technique at a full time level. Yet again it baffles me how you can attack a profession on the apprent lak of research for SMT and yet you dish out medication that has minimal research to support the benefits, wasn’t it only a short while ago that Diclofenac had proven to increase the risk of heart disease/stroke and yet I see my patients who present to me with failed results from GPs and Physios taking these like penny sweets! I don’t see the ego boost in wasting my time attacking other professions, and there have been times in which I have asked for the opinion of GPs to achieve the best care for my patient…surely thia should ve the main outcome?to be hibest im proud not to be working within the nhs, as its jn such a sorry state…the amount of ££ waste on unnecessary medication and procedures shock me. A recent example, I had a mid 40s female recently report to me, having undergone all examinations under the sun and failed physio treatment with no respond to anything. She responded to 3 chiropractic treatments. Can you imagine the amount wasted for a simple L2/3 issue?
    Suffice to say, I don’t think my comment is going to open your eyes, but one day I do hope we can all work together and achieve the same goal…

  21. Dr Richard Rawlins
    January 12, 2013 at 12:50 pm

    I’m not sure which posting Dr Bored was concerned about, but neitheer I, nor most other posters have “attacked” any profession.

    I(and I suspect other posters) simply want to move health care along. We constantly challenge our colleagues and peers in meetings, journals, conferences to describe what they are doing, have done, and hope to achieve. That is not an “attack”. That is peer review, critical analysis, a search for falsification. Fundemental to the scientific method. Why not join us? But of course you would have to justify (with good evidence, for which anecdote is but little part)just what you are up to.

    Are you sure you havn’t been seduced by metaphysical constructs and a world view at variance with plausibility? I do hope not. But please make positive contributions to developing health care systems, and set paranoia aside.

  22. John H
    January 12, 2013 at 1:02 pm

    Dr Bored With This

    Can you imagine how we feel?

    There would appear to be a crack in the veneer of open and reasonable discussion and answering all questions.

    I would point out that in terms of wasting time you have contributed by far and away the most words to this debate.

    You also refrained from answering my questions on VAD (I think you merely obfuscated), X-rays and using chiro for common childhood complaints. So much for openness.

    Do you not realise that saying things like “subluxations aren’t things that chiropractors claim to see, as such, they “claim” to feel them with their hands” sounds like some form of magical vitalism. Reiki perhaps. (as an aside I met an osteopath in Ireland last month who was appalled that people thought she did reiki but tried to convince me that the cranio-sacral rhythm was real and was something which could only be interpreted by an osteopath. Sounds familiar eh?).

    When you have to tout for business in shopping malls (rather like squeegee muggers) I really balk at the concept of your trade being a “profession”.

  23. Dr bored of this
    January 12, 2013 at 1:41 pm

    I personally do not use the terminology ‘subluxation’ and tout for business in shopping malls, I’ve built my business on the success of my outcomes. However, might I add if here wasn’t a health system in place just like the USA, medics, which I have seen, tout for business regularly. This is the research I possess which is good enough for me or anyone that questions my technique.

    Chronic Lower Back Pain

    “Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”
 Journal of Manipulative and Physiological Therapeutics, Nyiendo et al (2000).

    “In a Randomised controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counselling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.” 
British Medical Journal, Korthals-de Bos et al (2003).

    “There is strong evidence that manipulation is more effective than a placebo treatment for chronic low-back pain or than the usual care offered by general practitioners of bed rest, analgesics and massage.” 
Spine, Van Tulder and Bouter et al. (1997).

    “…improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear.” 
British Medical Journal, Meade et al. (1995).

    “Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.” 
British Medical Journal, Koes et al. (1992).

    “…patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.”
 Journal of Manipulative and Physiological Therapeutics, Verhoef et al. (1997).

    “…for the management of low-back pain, chiropractic care is the most effective treatment, and it should be fully integrated into the government’s health care system.” 
The Manga Report (1993).

    ……………………………………………………………………………………………………………………………………………………………….

    Headaches

    “Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.”
Duke Evidence Report, McCrory et al. (2001).
    The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values.”
 Journal of Manipulative and Physiological Therapeutics, Boline et al. (1995).

    ……………………………………………………………………………………………………………………………………………………………….

    For The Elderly

    “[Elderly] chiropractic users were less likely to have been hospitalised, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addition, they were less likely to use prescription drugs.”
 Topics in Clinical Chiropractic, Coulter et al. (1996).

    ……………………………………………………………………………………………………………………………………………………………….

    For Containing Costs and Getting Workers Back to work

    “Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.”
Journal of Manipulative and Physiological Therapeutics , Haas et al. (2005).
    First contact chiropractic care for common low back conditions costs substantially less than traditional medical treatment and “deserves careful consideration” by managed care executives concerned with controlling health care spending.”
Medical Care, Stano and Smith (1996).

    “The overwhelming body of evidence shows that chiropractic management of low-back pain is more cost-effective than medical management, and that “many medical therapies are of questionable validity or are clearly inadequate.” 
The Manga Report (1993).

    As long as my patient obtains the outcome they desire in the safest possible way then surely this is enough?

    • Dr Quack
      January 12, 2013 at 8:06 pm

      Beautiful selection! and there is soooooo much more as well. Although they all probably know that! And now that the Chiropractic Research Council, funded by voluntary contributions by the BCA members themselves, we will be generating more research than ever before! exciting stuff!

      PS for those who want MORE research to read, these are a few more major studies:

      Numerous studies throughout the world have shown that chiropractic treatment, including manipulative therapy and spinal adjustment, is both safe and effective.

      Manual Therapies Back and Neck Service, NHS North East Essex – Department of Health Case Study – published 19 July 2011; NHS North East Essex wanted to provide greater choice, easier access and shorter waiting times for patients suffering back and neck pain and at the same time address the unsustainably high demand on local spinal services.
      In 2008, all existing providers were contacted and invited to bid to offer patients these services.
      Patients can now choose from 20 different providers of chiropractic, osteopathy and physiotherapy based throughout the Colchester and Tendering area. There are four chiropractic, five osteopathy and 11 physiotherapy providers to choose from and they all meet NHS standards and agreed prices. Patients are given an appointment within two weeks and receive up to four treatments.
      During 2009/10, 2,810 patients used these services and 97% of patients were seen within two weeks of referral.
      Providers are working to locally agreed common referral and clinical protocols and whilst there is competition, there is also cooperation between individual providers and disciplines to ensure service integration for patients.
      Evaluation after the first 12 months of offering patients a choice of any qualified provider has identified improved patient access and choice meaning early treatment and improved outcomes; and reduced primary care consultations, imaging, medication costs and inappropriate referrals to secondary care. Referrals to spinal surgeons have reduced by more than 25%.
      To date this service has seen over 7000 patients.
      In 2009, this approach to offering chiropractic, osteopathy and physiotherapy services to treat back and neck conditions was awarded the NHS Alliance ‘Acorn Award’ for alternative therapy.
      The full case study can be read here
      http://healthandcare.dh.gov.uk/back-and-neck-pain-services/

      Bronfort; A report into the effectiveness of manual therapy, as practiced by chiropractors, manipulative physiotherapists and osteopaths for various common musculoskeletal disorders such as back pain and other health problems Effectiveness of Manual Therapies: the UK Evidence Report was published in February 2010. This found evidence that spinal manipulation/mobilisation is an effective treatment for acute, subacture and chronic low back pain; migraine and cerviocogenic headache; cervicogenic dizziness; manipulation/mobilisation is effective for several extremity joint conditions; and thoracic manipulation/mobilisation is effective for acute/subacute neck pain. The conclusions were based on the results of systematic reviews of randomised clinical trials, widely accepted and primarily UK and US evidenced-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories.

      NICE Guidelines; In May 2009, The National Institute for Health and Clinical Excellence (NICE) published new guidelines to improve the early management of persistent non-specific low back pain. The guidelines recommend what care and advice the NHS should offer to people affected by low back pain. NICE assessed the effectiveness, safety and cost-effectiveness of available treatments and one recommendation is to offer a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. This treatment may be provided by a range of health professionals, including chiropractors as spinal manipulation is part of the package of care that chiropractors can offer.

      UK Beam Trial; Back pain, exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. British Medical Journal Nov 2004; 329; 1377 (doi: 10.1136 /bmj. 38282. 669225.AE)

      Medical Research Council; ‘Low Back pain of mechanical origin: randomised comparison of Chiropractic from hospital outpatient treatment’; Meade et al.

      Medical Research Council (Follow-up-study) Trial ‘Randomised comparison of Chiropractic and hospital outpatient management for low back pain; results from extended follow up’; Meade et al.

      RCGP – Clinical Guidelines for the Management of Acute Low Back Pain (1996, 1999, 2001)

      Clinical Standards Advisory Group; Backpain Report 1994.

      Acute Back Pain – Primary Care Project; The Wiltshire and Bath Health Commission.

      Carter JT, Birrell LN (Editors) 2000. Occupational health guidelines for the management of low back pain at work – principal recommendations. Faculty of Occupational Medicine. London. Occupational health guidelines for the management of low back pain at work – leaflet for practitioners. Faculty of Occupational Medicine. London. 2000. Waddell G, Burton AK 2000. Occupational health guidelines for the management of low back pain at work – evidence review. Faculty of Occupational Medicine. London.

      Chiropractic Treatment in Workers with Musculoskeletal Complaints; Mark P Blokland DC et al;Journal of the Neuromusculoskeletal System vol 8 No 1, Spring 2000

      Musculoskeletal Services Framework – Department of Health July 2006
      The main treatment interventions, as recommended by the current evidence review and that of clinical guidelines is a biopsychosocial approach: a) Guidance on activity, lifestyle, prognosis and prevention. b) Physical treatments drawn from all types of manual therapy, spinal manipulation and rehabilitation exercise. c) Advice about pain control, including non-prescription medication. d) Psychosocial interventions aimed at resolving cognitive barriers to recovery.

      Non-rigid stabilisation procedures for the treatment of low back pain – National Institute for Health and Clinical Excellence. June 2006
      States that chiropractic intervention can be used in the treatment of acute low back pain.

      European guidelines for the management of acute nonspecific low back pain in primary care. 2005 Recommends the consideration of spinal manipulation for patients failing to return to normal activities.

      The Anglo European College of Chiropractic and Welsh Institute of Chiropractic, two of the colleges of chiropractic education in the UK, have full and varied research interests.
      The links to these research institutions can be found here:
      The Anglo European College of Chiropractic
      The Welsh Institute of Chiropractic at the University of Glamorgan

      • Alan Henness (aka Zeno)
        January 12, 2013 at 9:33 pm

        What do you believe Bronfort adds to the evidence for chiropractic manipulations?

        • January 13, 2013 at 1:27 pm

          It looks like Dr Quack isn’t going to answer your question about Bronfort and the evidence for chiropractic. Put perhaps we shouldn’t be too surprised. After all, it seemed to cause the General Chiropractic Council to contradict itself:

          “…the GCC can’t maintain that Hancock is irrelevant because it’s not about chiropractic manipulations, yet allow their prized Bronfort Report off the hook when it cites trials mainly not about chiropractic.

          Once all those non-chiropractic manipulations have been removed from the Bronfort Report, what’s left?

          Not a jot.”

          http://www.zenosblog.com/2010/11/where-the-evidence-leads/

      • January 13, 2013 at 1:02 pm

        Dr Quack wrote: “The Anglo European College of Chiropractic
        and Welsh Institute of Chiropractic, two of the colleges of
        chiropractic education in the UK, have full and varied research
        interests.” I think you’ll find the the Anglo European College of
        Chiropractic (AECC) has a pretty dubious track record with regard
        to research:
        http://www.ebm-first.com/component/search/?searchword=anglo&searchphrase=all&Itemid=101
        As for the Welsh Institute of Chiropractic, enquiries have been
        made in the past regarding the science base for its teachings:
        http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1556-an-email-to-the-university-of-glamorgan.html
        I understand from the neuroscientist who made the enquiries that
        they were met with evasive responses.

  24. English spinal surgeon 35 years
    January 12, 2013 at 3:53 pm

    Hello all,

    I am a spinal surgeon of 35 years. I am appalled at the childish nature of the medical doctor posting above. i have worked as a neurosurgeon and i am dedicated to keeping up with current reasearch. chiropractic is the best manual therapy profession with the most significant training, education and have on numerous occasions often had better knowledge than myself and collegues. I have worked alongside chiropractors for years, with thousands of people avoiding surgery as a result. They are a very regulated profession, with significant funding on reasearch. Their education is a full time 5 year masters degree, whereas physiotherapists is a 3 year degree. NHS physiotherapy has such poor results and their knowledge base is no better than nursing. No chiropractor i have worked with has ever used the term subluxation, its an old fashion term which you may think they use but its redundant. His statistics on VBI/stroke is correct. A medical risk is seen as 1 in 10,000. Paracetamol has a higher risk. Drugs kill more per year than you can imagine. If someone is if high stroke risk etc as the chiropractor above stated, you wouldn’t use SMT of the cervical spine. It’s the work of an unfortunate few, much like surgery that sometimes get it wrong. I support chiropractic solely and continue to work very successfully together. Thanks

    • Dr bored of this
      January 12, 2013 at 5:06 pm

      Thank you so much for your kind and positive words!

    • January 12, 2013 at 6:10 pm

      English spinal surgeon 35 years said:

      No chiropractor i have worked with has ever used the term subluxation, its an old fashion term which you may think they use but its redundant.

      Redundant?

      Vertebral Subluxations

      Chiropractors locate and correct vertebral subluxations, a spinal condition that affects nerves, muscles, fascia, meninges and other tissues. Subluxations can alter the concentration of enzymes and other chemicals necessary for skeletal muscle health which may play a role in muscle diseases. Compression of a nerve interferes with impulse transmission, causing muscle paralysis, vasodilation and trophic ulcers.

      Source

      …however, as 97% of the world’s Chiropractors accept and utilise the terms Vertebral Subluxation Complex and Subluxation at this time we feel it is important information to be included on this site.

      Source

      These blockages are known as ‘subluxations’, and can affect any part of your body, preventing you from functioning to the best of your ability. Chiropractic is a highly skilled and developed approach to removing subluxations, allowing your body to fulfil its maximum potential.

      Source

      The chiropractic subluxation complex is a functional biomechanical spinal lesion with purported altered neurological function that can result in neuromusculoskeletal and visceral disorders.

      Source

      And here’s a diagram showing a subluxation.

    • Dr Richard Rawlins
      January 12, 2013 at 6:51 pm

      Dear Mr. English Spinal surgeon Age 35.

      Your name is? And you work where?

      Thank you.

      • Dr Quack quack
        January 12, 2013 at 7:27 pm

        Watch out Mr Surgeon, the Gestapo are on to you!

      • Dr bored of this
        January 12, 2013 at 7:28 pm

        He’s not 35 years old…he’s been a spinal surgeon for 35 years! I hope you are more thorough with your patient details

      • Dr Quack quack
        January 12, 2013 at 7:31 pm

        Sorry Dick, my friend ;-)
        Couldn’t resist!

        Hope you don’t mind me calling you Dick? As in short for Richard of course!
        I wouldn’t want anyone thinking I was calling people names on a “professional forum”

  25. English spinal surgeon 35 years
    January 12, 2013 at 7:39 pm

    This may be a definition of a subluxation. However I haven’t met a chiropractor that uses this term. Obviously if there is arthritic degeneration of loss of segmental movement, then manipulation can often improve normal joint mechanics over a suitable period of time. For the same reason that exercise aids mobility. However if the joint is severly arthritic or chronically inflammed, treatment such as chiropractic will restore normal joint function so normal ROM etc/ exercise can start. I work in London, and have been qualified 35 years. I won’t disclose my name as its not appropriate.

    • January 12, 2013 at 8:08 pm

      English spinal surgeon 35 years

      You said that ‘subluxation’ was ‘an old fashion term which you may think they use but its redundant’. I have provided you with several (very easily found) examples of chiropractors currently using it to describe what they do and for them it seems far from redundant, using it as they do to define themselves and mark themselves as different form others.

      Are they all wrong and should they correct their out-of-date websites?

    • Dr Richard Rawlins
      January 13, 2013 at 11:54 am

      You may call me what you like, but please do not suggest I have any affinity with the Gestapo. That would be offensive if I felt you were serious.

      Why will you not tell us what your name is? Are you the same person as Mr English spinal surgeon 35 years?

      How are we to know?

      And how do we know whether Mr English spinal surgeon is himself 35 years old, or has been a spinal surgeon for 35 years,as Dr Bored suggests? How does he know? Is he the same person?

      Why won’t Mr Spinal tell us his name? Of what is he embarassed?

      The Quackometer was initiated to expose fraud, deceipt, dishonesty. So let’s start by knowing who we all are. Why not?

    • January 13, 2013 at 12:49 pm

      English spinal surgeon 35 years wrote: “… I haven’t met a chiropractor that uses this term [subluxation]”

      Then you need to get up to speed with the facts.

      Evidently you are not aware of the lobby group, the Alliance of UK Chiropractors (AUKC), which has a combined membership of several hundred chiropractors, most of whom are existing members of either the McTimoney Chiropractic Association (MCA), the United Chiropractic Association (UCA), or the Scottish Chiropractic Association (SCA). Although the AUKC’s members are all regulated by the General Chiropractic Council, the group has, alarmingly, adopted the International Chiropractors Association (ICA) Best Practices documentation which, among other policies, supports 27 indications for chiropractic radiography including (mythical) spinal subluxation, birth trauma, facial pain, skin diseases, organ dysfunction, eye and vision problems, and hearing disorders, and recommends a basic care plan for simple uncomplicated axial pain (neck pain, back pain, etc) consisting of 25 visits over 8 weeks – with the presence of ‘complicating factors’ (including family/relationship stress, lower wage employment, and wearing high-heeled shoes) warranting a recommended additional 12-visit blocks of care.

      Ref: http://en-gb.facebook.com/note.php?note_id=153048378097052

      A licence to print money? I think so.

      • January 13, 2013 at 12:54 pm

        BTW, English spinal surgeon 35 years, just because some chiropractors don’t use the term ‘subluxation’ (the non-orthopaedic type) doesn’t mean that they don’t still buy into it. There are over 329 terms relating to it – more than enough to bamboozle patients…
        http://forums.randi.org/showpost.php?p=5404275&postcount=14

  26. Dr Quackgood
    January 12, 2013 at 8:25 pm

    Lets get this subluxation issue out the way. This is a historical term (c. 1897) used to described what was perceived as a blockage in the spine. The pseudo-science adhered to this term was based on the perceived significance of this blockage. For its time it was thought, by the pioneering chiropractors, that blockages in the spine reduced “nerve flow” that guided the life force essential for health. Indeed a lack of nerve flow resulted in dis-ease (a lack of ease). Ergo by removing these blockages, restoring normal flow of innate intelligence the patient would report a lack of “dis-ease”.

    Obviously any rational person doesn’t believe that, and those who do aren’t worthy of our discussion. The usual questions arise: “Can you measure it?” “Can you see it?” “How do you know it exists?” None of these questions have been satisfactorily answered, which relegates subluxation fundamentalist theory to the annals of archaic medicine (along side blood letting, Quackery and the 4 humours of the human body).

    What did prevail, however, in around the 1920s was the science and art of chiropractic. Clearly some patients were reporting an improvement in symptoms after manipulation, and along side the advancement in medicine, chiropractic was studied for what it was – manual therapy of the musculoskeletal system. With contributors within and outside of the profession, spinal biomechanics describes how chiropractic manipulation was of benefit to patients with mechanical lesions. Works by Kirkaldy-Willis, Bogduk, Panjabi and White laid foundations on which modern chiropractic, the chiropractic we were taught, are built. We are, in essence, experts in manual therapy. Identifying the manipulable lesion; its role in pain and dysfunction; and the benefits of its precise and careful correction. Can we measure this? It’s very difficult to quantify these lesions as they are defined by their symptoms that vary considerably from patient to patient. All do display palpable joint motion restriction, local or distal biomechanical aberration (usually degenerative in chronic patients) and myofascial changes (hypertonicity, trigger points, muscle weakness, altered reflexes). It is our job to know when and what is appropriate for the individual patient, and when to refer patients outside of our scope of practice.

    I still use the word subluxation, but only with people who know what I’m talking about, and not in the historical definition of the meaning. If I told my colleague “I adjusted a posterior right L5 subluxation” I didnt mean that the patient now has more life force flowing through his or her L5 nerve root. What I did mean is that I determined that the L5 segment was restricted in a particular direction that I corrected by applying a high velocity low amplitude thrust through the articular structures of the L5 motion segment to restore biomechanical function locally or globally. I also say “I made a birdie” but only with people who know that I mean I play golf, and on a particular hole I completed in one under par, not that I have created a small winged animal.

    Please keep asking questions. I hope our answers help

    • Alan Henness (aka Zeno)
      January 12, 2013 at 9:56 pm

      When do you believe the subluxation was last taught to chiro students in the UK other than as an historic concept?

    • Andy Lewis
      January 12, 2013 at 10:02 pm

      Do you think our surgeon would be taken serious if he talked with his colleagues about ‘removing evil spirit from spleen’ even if he just meant it as some sort of metaphor? All you have done is shift your metaphyscial perspective without caring if it has any bearing on reality. It is as if homeopaths started talking about ‘quantum vibrations’ rather than ‘vital forces’. Do we need to take them seriously too just because they have shifted language?

    • January 13, 2013 at 11:40 pm

      Dr Quackgood said:

      I still use the word subluxation, but only with people who know what I’m talking about, and not in the historical definition of the meaning.

      I’m still none too sure what you do mean by ‘subluxation’. Do you mean any kind of definite mis-position of one vertebra relative to another? And what causes this mis-alignment?

  27. Sarah
    January 12, 2013 at 10:17 pm

    You are both trouble makers (Andy Lewis, Alan Hennessy), google shows your true colours. 2 diseased individuals making money asking ridiculous questions. 2 lonely middle aged men, with nothing better to do that slag of others intent to help. Your profiting upon stirring up nonsense, where us your ethics! Who cares if chiropractors use the word subluxation to describe basic mechanics of a joint so they understand. There is slang in every profession, shorthand. Even surgeons use inter profession slang to describe what they have done. Obviously not written down, but talked out in discussion. We use medical jargon in our G.P surgery which is not meant in the literal sense. Edinburgh G.P

    • January 12, 2013 at 11:50 pm

      Sarah

      Please try to get my name correct, but do you have anything better to offer than insults?

      Do you think the public are entitled to make their healthcare choices knowing all the facts, or just a selection of them?

    • January 13, 2013 at 1:10 am

      “2 diseased individuals making money asking ridiculous questions. 2 lonely middle aged men, with nothing better to do that slag of others intent to help. Your profiting upon stirring up nonsense, where us your ethics!”

      Well you sound like a right nasty piece of work. You’re not seriously claiming to be a GP are you?

  28. Dr Quackgood
    January 12, 2013 at 11:38 pm

    I wouldn’t expect him to be taken seriously at all Mr Lewis. In the same way I wouldn’t be expected to be taken seriously if I told you my intentions were to restore innate intelligence by correcting subluxations. But that’s exactly what I’m not saying Mr Lewis. I use the term subluxation, to describe a mechanical lesion and not the philosophical affect it has. Following your comparison, our surgeon could be taken seriously using the term hysterectomy to describe removing the uterus from a patient, but not because he believes it is causing her to be hysterical (the origin of the word hysterectomy).

    What is real, Mr Lewis, are the patients that visit chiropractors. Those patients have real problems that require real results. They don’t care about what you think about the universe Mr Lewis, they care about their back pain. I apply my skill in diagnosing and treating their problem and communicating that to my peers. I also have a desire to find out what causes their problems in the first place, and advise them accordingly.

    I cannot comment on homeopathy – it’s not my profession. It’s up to them to justify their existence.

    • Andy Lewis
      January 13, 2013 at 12:41 am

      You are nothing but a dog who thinks his barking has scared off the postman.

      • Dr bored of this
        January 13, 2013 at 12:43 am

        You are nothing but a TWAT

      • Andy Lewis
        January 13, 2013 at 12:45 am

        That is a serious point. Your patients may believe your bone crunching did them good. You may believe that too. But since lower bacl pain is a self-resolving issue why should you associate your actions with any improvement?

        That is the central problem with all quackery.

        • Dr bored of this
          January 13, 2013 at 12:51 am

          If its self resolving as you claim, why did the NICE Guidelines in 2009 recommend smt for chronic low back pain? If its self resolving why do so many prescribe medication/ administer cortisone injections to ”resolve” this common ‘self-resolving’ complaint?

          • Andy Lewis
            January 13, 2013 at 12:54 am

            It puts it on a par with a couple of paracetamol. The truth is we do not know how to treat lower back pain effectively.

            And as for chiropractic, NICE made some fundamental errors there.

            http://www.dcscience.net/?p=1516

            And whilst some things may reduce pain temporarily (possibly a back crack), we do not have any therapies that actually resolve most problems. Chiropractors admitting that would be a big thing.

        • Ben
          January 13, 2013 at 12:54 am

          Tell that to a patient that has had back pain for 30 years, no surgeon will touch them. Drugs don’t touch the pain. Do they not deserve a chance of being pain free?! Because this occurs on the daily basis. I could show you 1000 testimonial like this. They would tell you to fuck off! You have no idea what your talking about as your not a doctor!!!!! Fuck off… Ps your shift as asda starts in 10 minutes. Your website is shit. Your Jelious that you don’t get to help the thousands abandoned by medicine.

          • Andy Lewis
            January 13, 2013 at 12:56 am

            citation needed

          • Dr bored of this
            January 13, 2013 at 1:03 am

            Andy, take all the paracetamol you want…I’d rather keep my liver in tact an have an adjustment!

          • Andy Lewis
            January 13, 2013 at 1:06 am

            I have suffered from bad back pain. Keeping mobile, a few pain killers when required, and all resolved. I could easily have been suckered into spending £100′s of pounds with a spine wizard over many weeks of “treatment” and then “maintenance”, but fortunately, I had access to good information – which a chiro would never have given me.

            I knew the postman would go without anyone barking.

          • Andy Lewis
            January 13, 2013 at 1:07 am

            And of course, you have still to explain what it is exactly you are ‘adjusting’. You have had 100 years to get to the bottom of that.

      • Dr bored of this
        January 13, 2013 at 12:46 am

        This is a rather unfair post! You are nothing but a T W A T

        • Dr bored of this
          January 13, 2013 at 1:19 am

          I believe the likes of David Beckham, Venus Williams, Tiger Woods, Andy Murray and Bradley Wiggins, to name but a few, have utilised regular chiropractic care to keep them at the top of their games. All of which have quoted the benefit of the treatment. I’m sure spending a few £100 pounds on care to get them earning a whole heap more and winning and being at the top of their chosen sport is of great value to them. I’d like you to challenge them on their decisions to have chiropractic treatment to keep them at their optimum…none of them were quoted stating ‘paracetamol kept me at the top of my game.’ On a smaller scale, the average Joe Bloggs who is told to ‘rest’ who relies on work to put bread on the table equally values the relief from chiropractic care they receive which allows gem to return to work as quickly as possible. In your opinion it may be temporary relief but surely that’s enough to get them back in their feet and earning again as statutory sick pay does not cover the average household monthly expenditure! I’m ire you feel spending £100s on chiropractic is a waste of money but for some its nothing to get them back to their normal activities!

          • Mojo
            January 13, 2013 at 11:42 am

            I believe the likes of David Beckham, Venus Williams, Tiger Woods, Andy Murray and Bradley Wiggins, to name but a few, have utilised regular chiropractic care to keep them at the top of their games.

            It’s no more convincing when you do this than it is when Dana Ullman does it.

          • Andy Lewis
            January 13, 2013 at 12:21 pm

            Of course, there is no evidence whatsoever that chiropractic can help sports performance. I see it as nothing but a scam with the only mitigating factor being that the scam is often perpetuated by the unwitting.

          • January 13, 2013 at 12:40 pm

            Dr bored of this wrote: “I believe the likes of David Beckham, Venus Williams, Tiger Woods, Andy Murray and Bradley Wiggins, to name but a few, have utilised regular chiropractic care to keep them at the top of their games. All of which have quoted the benefit of the treatment.”

            There is no conclusive evidence that chiropractic helps to treat or prevent sports injuries:
            http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2011.01111.x/full

            Remember, superstition is rife among athletes. If they thought a witchdoctor would boost their performance, they’d bring one in. Having a chiropractor on hand to crack a few joints could simply be another form of pulling on ‘lucky socks’.

          • J Rowlands
            January 13, 2013 at 1:21 pm

            Sports teams and professional dance companies are major employers of physiotherapists, not chiropractors. So in high performance physical disciplines where there is a lot of money at stake people choose what works, and that is generally physio. I’ve certainly never come across a professional dancer using chiropractic.

            Of course dancers and athletes are going to do all the work that it takes to get themselves 100% back into shape, and that’s the main difference: for a completely passive approach to physical problems, see a chiropractor. But chiropractic will not fix the problem, just manage some symptoms, hence the interminable repeat visits which are the basis of the chiro business model.

  29. Sarah
    January 13, 2013 at 12:07 am

    I have read all your comments and have yet to find one that warrents a response. Why don’t we start on drugs and the lack of evidence based medicine we all live and trust. Is there a drug that can sort out arthritis in a joint? We all know that drugs are made and sold on the basis of financial gain. Bribes to medics to prescribe medicine that’s not clinically beneficial. I am currently leaving medicine. The use of subluxation is the least of our worries. Medicine kills daily.

    • Acleron
      January 13, 2013 at 2:21 am

      The partial lack of evidence for drugs is worrying and is being addressed. The almost complete lack of evidence for alternatives is horrifying and is not being addressed by the practitioners.

      • Dr bored of this
        January 13, 2013 at 2:18 pm

        Can you by see the evidence provided by myself and my colleagues above? The BMJ has also been quoted. If these sports people, who are far more successful than you believe it helps them then let them be. I believe dance groups and sports teams hire Physios because thy come at a much cheaper price. I believe that a few of the premier league teams in the Uk have started to utilise Chiropractic, physiotherapy, a course which takes 3 years to train in is beginning to show its true colours, anybody can dish out some exercises and stretches but sound ubderstanding of the complex musculoskeletal system takes a long time an continued commitment to be able to treat it. We are required every year to provide 30 hours of CPD, how many are Physios asked to do? I have relatives and friends in the medical profession who are shocked at the course requirement we as chiropractors go through, the same can also be said for osteopaths. It’s frightening how you back medicine which has less, positive evidence than us to be up with the gold standard. Don’t get me wrong, if I was hit by a bus, take me to A&E but for chronic conditions I wouldn’t be found within 10 miles of the place! Wasn’t there a famous quote along the lines of ‘whilst money can be made from cancer, there will never be a cure’ This somes up medicine for me…I’m leaving this forum now because all I see is narrow minds and the realisation has hit, you don’t want what’s best for the patient, you wan an ego boost, I couldn’t give two s***s who helps my patient, as long as they get the best result, and if I have to send them on for further investigation than I’m big enough to admit that…can the same be said for you?!

    • Dr Richard Rawlins
      January 13, 2013 at 12:12 pm

      Dr Sarah,

      Are you sure you were ever in ‘medicine’ in the first place? Why are you leaving?

      Please tell us who you are so that we can grant you the respect you deserve.

      If you remain annonymous your wise words will fall on stony ground.

      Yes, it does matter that we know who you, and Dr Quack, and Dr Bored, and Mr Spinal are.

      You could all be pychopaths, deranged, frauds, seriously ill – who knows? If you post on a site for ranters who find it funny, or need a cathartic release by using four letter words, and if you wish to engage in ad hominem attacks -there are plenty of sites to satisfy your needs.

      But IMHO the Quackometer engages serious professionals in discussions about quackery – and the harm that does to patients.

      At times we joke, but we nearly all know who we are. I’ve even met Andy Lewis – so he know who I am! The underlying intention is to expose and comment on Quackery. lets get on with that shall we?

      So, lets start by using our real names, or stating who we are. It’s called honesty and integrity Mr Spinal.

      Richard Rawlins
      MB BS MBA FRCS MMC

    • John H
      January 13, 2013 at 12:25 pm

      Sarah

      Is your departure from medicine voluntary?

    • January 13, 2013 at 1:39 pm

      @Sarah

      Well you if you find the zeno’s question too difficult, let me ask you one about a topic you introduced:

      What is the ‘disease’ you have diagnosed two people having and who is paying them “to ask ridiculous questions”, as you allege?

      “Edinburgh GP” my arse.

  30. January 13, 2013 at 1:06 pm

    To all those chiropractic apologists here who are citing the Meade study (and follow-up), and BEAM trial, as proof of chiropractic’s effectiveness, please read these criticisms:
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1198-criticism-of-the-meade-report-.html

  31. January 13, 2013 at 1:12 pm

    As for those citing the NICE guidelines as an endorsement of chiropractic, the guidelines did not consider the risks associated with the many (97% according to a link provided by Alan Henness above) mythical subluxation-based practices:
    http://tinyurl.com/6b6nkzg

    So, until chiropractors get their act together and drop all the quackery, the risks of chiropractic treatment for low back pain will outweigh any small benefits.

    • Alan
      January 13, 2013 at 3:33 pm

      It would appear that the chiropractors who have posted on here have demonstrated clearly that they have ‘got their acts together’. They have provided you with a lot of research indicating chiropractic to be safe and effective. I do not see you providing good evidence that shows that the risks of chiropractic treatment for low back pain outweighing the benefits. So far your ‘evidence’ seems to
      mostly consist of websites pointing out the flaws in chiropractic research. Whilst there is no denying the importance of good critique, this in itself does not constitute evidence to the contrary.

      Also the figure of 97% of chiropractors claiming to treat ‘subluxations’ (apologies, I could not find the proper reference above) is quoted as being worldwide. This statistic, therefore, is not valid when applied to UK chiropractors, whom I think have proven here are largely not of this persuasion. As Dr Quack stated earlier (and seemingly was largely ignored) it is the minority of unethical chiropractors that need to be held to account, not the vast majority whose goal is to do their best for their patients.

      I look forward to seeing the peer reviewed evidence to back up your arguments. I think the chiropractors have provided plenty to back up theirs.

      • January 13, 2013 at 3:57 pm

        Alan wrote: “I do not see you providing good evidence that
        shows that the risks of chiropractic treatment for low back pain
        outweighing the benefits. Here’s some: Quote “Chiropractors view
        the spine as an entity. Where they diagnose ‘subluxations’, they
        will normally manipulate and ‘adjust’ them (11). And ‘subluxations’
        will be diagnosed in the upper spine, even if the patient suffers
        from back pain. Thus many, if not most back pain patients receive
        upper spinal manipulations. It follows that the risks of this
        treatment should be included in any adequate risk assessment.” Ref:
        Spinal manipulation for the early management of persistent
        non-specific low back pain — a critique of the recent NICE
        guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009)
        Reference (11) is Ernst E. Chiropractic: a critical evaluation. J
        Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a
        report that indicates that only 11% of all cervical manipulations
        are “appropriate” and gives the reference Coulter I, Hurwitz E,
        Adams A, et al. The appropriateness of manipulation and
        mobilization of the cervical spine. Santa Monica, CA: RAND,
        1996:18e43. Alan wrote: “So far your ‘evidence’ seems to mostly
        consist of websites pointing out the flaws in chiropractic
        research. Whilst there is no denying the importance of good
        critique, this in itself does not constitute evidence to the
        contrary.” Have you got anything better than the content of the
        following two links?
        http://www.ebm-first.com/chiropractic/research-and-efficacy.html
        http://www.ebm-first.com/chiropractic/risks.html

        • January 13, 2013 at 3:59 pm

          Alan wrote: “Also the figure of 97% of chiropractors claiming to treat ‘subluxations’ (apologies, I could not find the proper reference above) is quoted as being worldwide. This statistic, therefore, is not valid when applied to UK chiropractors, whom I think have proven here are largely not of this persuasion.”

          Wrong. Around 70% of UK chiropractors buy into vertebral subluxation theory. See here: http://tinyurl.com/avlwx3z

          If you have any more recent figures, please provide them.

        • Alan
          January 13, 2013 at 4:51 pm

          Thank you for your response, I find this better than what has been posted here previously. I do not have anything to add other than what has already been posted above. As clearly people on both sides of this argument are not going to change their minds, I don’t really have anything more to say. I’m just pleased that there is at least some research to back up some of the very critical comments directed towards chiropractic.

      • Dr Richard Rawlins
        January 13, 2013 at 5:28 pm

        Chiropractors use techniques which may provide benefit.Fine. No problem. We can accept that. We can argue about the evidence, and the extent to which patients benefit, but let’s just accept that the manipulative techniques do provide some relief for some people. And can be provided also by osteopaths, doctors, physiotherapists.

        Chiropractic is a “Primary healthcare profession”. That is, patients will attend a chiropractor in the first instance before being referred, if necessary, to secondary care. Chiropractors have to make an initial diagnosis, they will investigate, examine, and then devise a treatment programme. They are practicing medicine, albeit unlicensed by the GMC. Some even claim to be doctors.

        They have entered the chiropractic profession because it entertains beliefs about subluxations, adjustments, distant somatic effects thereby, innate intellegence, vital spirits, metaphysical constructs and a distain for the principles of scientific research.

        If they do not hold to those beliefs, they can hardly call themselves chiropractors – they are heretics. It would seem they have entered the wrong profession. Or failed to leave it.

        We should help them all we can and not abuse them in their hour of need.Let us all try to move on. Science cannot prove non-sense is nonsense. We have to make a judgement about the likelihood any proposal is true. Most healthcare professionals who have looked at the claims advanced by chiropractors have judged them to be highly improbable, and therefore chiropractic is an alternative to regular orthodox medicine.

        As long as patients understand that, and give informed consent, I have no problem. Put deceipt, deception, denial into the mix and we might have quacks. If they seek to gain pecuniary advantage thereby – possibly frauds. How are we to tell?

        (Contingent phrases and words included to avoid claims of libel).

  32. Miss Happy Patient
    January 13, 2013 at 1:52 pm

    I had low back pain from my teenage years through to my mid twenties. I was a very active child, doing ballet and other dance several times a week from age 5, playing hockey for a team, swimming twice a week – to give you a background that I was very strong and flexible. I went to the GP when I was in my late teens, to be told to ‘stretch more’….!! So I just carried on as I was. My pain didn’t resolve, or ‘self-limit’, it continued, for years, and it affected my life. I know many people like this, whose pain doesn’t resolve naturally. Eventually, on a trip to LA my relative who lived there said to me ‘why don’t you just see a Chiro!?’ …’a what?’ I’d never heard of Chiro’s or Osteo’s before. So I went to see her Chiro, he was very nice, he did a thorough physical exam and adjusted me. I don’t remember any talk of ‘subluxation’ or ‘innate intelligence’, I remember a very mechanical explanation, the adjustment was comfortable if a little surprising, and GREATLY reduced my pain which remained improved.

    That was about 15 years ago now. I’ve since seen other Chiro’s for headaches (again, they were a chronic problem that hadn’t resolved on their own) which I had great relief from, and now every now ant then if I have a mechanical problem with my body. If you had a machanical problem with your car would you not rather get it fixed than just let it carry on and cause other problems?! I’ve always found them to be very competent, effective, ethical, and a very positive experience from which I get instant and lasting relief.

    I find it very insulting to myself, and other patients who know their own body and own mind, when people insinuate that it’s nothing more than placebo or that it would have got better anyway, and that it’s all ‘quackery’. Really, we’re not that stupid! The Chiropractor has always answered my questions with mechanical and physiological explanations that make a lot of sense. I am practically minded, educated to degree level and run my own business in the conservation sector, so I repeat, I’m really not particularly stupid! Friends and family who’ve followed my advice to ‘just go and see someone’ have also been very happy, and grateful (usually saying to me ‘I should have done this ages ago’) for the treatment. They are also not stupid people.

    I find it sad that people who could potentially get help are put off trying something very positive and effective, and fundamentally basic (it’s restricted, lets get it moving, it’s tight, lets relax it), by reviews such as this. Reviews done under the guise of ‘informing potential patients’ but actually just seem to insult and nit-pick, going over the same old thing. Reading through all the comments I feel the Chiropractors have explained themselves well, the critics seem to be just repeating the same questions over and over again even though they have been answered.

    I also find it very bizarre that people (the chiro critics I’m talking about here) can accept that other therapies don’t work for everyone, every time – such as medications, surgery, exercise, etc. – but seem to expect a 100% success rate for Chiropractors/Osteopaths/Acupuncturists/etc??!! The human being is a very complex thing, on many levels, and to expect that one thing will work 100% for every type of case on every type of person with every type of upbringing/lifesyle is a little…. unrealistic?

    How about a little balance, kindness and open-mindedness? After all, the guy who fist had the idea of ‘germs’ – little pathogens that could be transported on our hands – and desperately tried to enforce the washing of hands in hospitals, ended his days in a mental asylum because all his contemporaries thought him mad for his crazy ideas!

    • January 13, 2013 at 2:06 pm

      Miss Happy Patient wrote: “I find it very insulting to myself, and other patients who know their own body and own mind, when people insinuate that it’s nothing more than placebo or that it would have got better anyway, and that it’s all ‘quackery’. Really, we’re not that stupid!”

      No, not stupid, but I would venture that you are misinformed. Please read this:
      http://web.archive.org/web/20110723060336/http://www.crhp.net/article1.html

      Many chiropractors, and other alternative medicine proponents, are subject to biases that also prey on their customers’ errors of reasoning.

  33. Badly Shaved Monkey
    January 13, 2013 at 3:25 pm

    My goodness, what a lot of recent posts. I’ll take the liberty of replying to Dr Quack with a new stem post at the bottom of the thread rather than losing this up in the earlier branches.

    perhaps you could have gone outside or asked for contact details to get in touch and ask him the same questions?

    Because I wasn’t that interested and because he’d just told me that his students had “run rings” around Edzard Ernst when he visited, which I rather doubted to be true and suggested limited scope for useful discussion.

    A name, a name, a name…

    Thank you, Humpty Dumpty. Names help us know we are talking about the same things. Chiros dance around this which looks like deliberate obfuscation.

    Again it seems like a question of needing to label everything accurately to make the world around us less scary.

    See above. How do you expect to engage in rational debate if you can be so coy about your basic locus of activity?

    Inter-examiner reliability has been shown to be poor when performing orthopaedic tests, or palpating the spine and muscles (or any other body part). However INTRAexaminer reliability is good.

    That really is the end of your meaningful career in this discussion and with patients.

    You have just accepted that you can make up your own diagnoses. All that matters to you is that you keep your story straight for the same patient. There is no external standard against which your claimed diagnosis can be judged.

    It really doesn’t matter what you think you’re diagnosing; all you then do is apply your back-whacks to the hurty bit. Repeat until patient runs out of money or gets better.

    The lack of underlying diagnosis behind your whacking wouldn’t matter too much if you got patients better more effectively than less expensive interventions like exercise and pain relief. It is being discussed elsewhere in other branches of this discussion, suffice to say there is no good evidence you can do this.

    You are aware that chiros do claim to be able to treat non-musculoskeletal diseases. It seems you share with us the conclusion that these claims are ill-founded.

    How is it demonstrated that a facet joint problem is causally connected to any problem of the patient?

    I find this question a little odd. If we press on something and the patient says “Ouch that’s the area and that’s what hurts every day!” Then I guess we have our answer.

    No you don’t. We have just agreed that you have no objective basis for asserting such a diagnosis. A repeated problem one has debating SCAMsters of all stripes is that they cannot maintain a consistent story from one sentence to the next. It reads like every comment you make serves only to serve the purpose of answering an immediately preceding comment or question. The reason is, and you have agreed to it even if you don’t realise it, is that you have no overarching coherent narrative based in facts to tie everything together. So, no you don’t know that a vertebral facet problem is to blame when you press on the hurty bit, you have already admitted this.

    How is it demonstrated that any manipulation made by you alters those facet joints?
    We can test pre and post manipulation of course.

    But you have already agreed that this cannot be done accurately across observers and you cannot produce any objective external diagnostic test to support it.

    We locate the facet joint (if indeed it is the facet joint we need to treat

    Non-medical readers of this page may not know that a vertebral facet joint is buried beneath skin, muscle and fat. It is unsurprising that they are difficult to palpate in meaningful diagnostic detail. I have no doubt that a patient may report a sensation of pain at a specific location, but it is quite a stretch to assert that this relates specifically to a facet joint. Also, unless your vertebrae are made of rubber, it’s pretty hard to have a facet joint out of position without the rest of the vertebra being differently positioned.

    Which brings us to the great chicken and egg problem of chiropractic. Your spine is held by muscles and ligaments. If you hurt any if these you  may create stiffness of the muscle. In addition the patient will consciously hold him/herself to protect the area. It is very easy to suppose that any palpable deviation in the area is secondary to these effects. A whack on the area might alleviate the muscle spasm, but all this talk about facets, or “chiropractic subluxations” is just a proxy and utterly unhelpful to any understanding of the problem or its solution.

    If a patient suffers an acute disc prolapse there will be pain, muscle spasm and deviation. All your magic fingers are doing is telling you rather imprecisely there is some pain at a certain spinal location. It’s a whole different question as to whether whacking a back makes any difference to the outcome for that patient.

    Watch this video. I have lined to it previously in the WDDTY thread.

    http://www.youtube.com/watch?v=GdaEsfXoBXE

    If you find this to be anything other than laughable you are either a chiropractor or one of their gullible patients. I just love the handheld gizmo that he runs up and down Justin’s back, I’d love Dr Quack to explain how this accurately and reliably detects conditions of the vertebral facets.

    The serious bit comes in the first few seconds with the line;

    “He’s been a patient, er, how long, a few years?”

    I think that says it all.

    • Alan
      January 13, 2013 at 3:39 pm

      If you think this is how all chiropractors practice, you are grossly misinformed. The only thing you’re right about is the video being laughable.

      • Badly Shaved Monkey
        January 13, 2013 at 3:53 pm

        Bingo! First line, first fallacy. That, Alan, is the No True Scotsman. It’s one of my favourites.

        Pray tell, what is wrong with that chiropractor.

        Must go and walk the dogs. I’ll leave you to mull over an answer. Don’t run away now.

        • January 13, 2013 at 4:02 pm

          BSM: Have you counted the number and variety of fallacies in Miss Happy Patient’s comment?

          • Badly Shaved Monkey
            January 13, 2013 at 6:18 pm

            Hmm…The wrongness strong in that one it is, yes.

            For a bit of fun I’ve had a go. It can be quite hard to link every piece of wrongness with a specific fallacy type and some contain elements of more than one fallacy or have fallacies concatenated. It turns out that Miss Happy Patient said nothing that wasn’t fallacious in some way. This is not unique in SCAMsters but it does take some effort to say nothing of any merit.

            Thanks to Wikipedia;

            1. I had low back pain from my teenage years through to my mid twenties. I was a very active child, doing ballet and other dance several times a week from age 5, playing hockey for a team, swimming twice a week – to give you a background that I was very strong and flexible. I went to the GP when I was in my late teens, to be told to ‘stretch more’….!! So I just carried on as I was. My pain didn’t resolve, or ‘self-limit’, it continued, for years, and it affected my life. I know many people like this, whose pain doesn’t resolve naturally. Eventually, on a trip to LA my relative who lived there said to me ‘why don’t you just see a Chiro!?’ …’a what?’ I’d never heard of Chiro’s or Osteo’s before. So I went to see her Chiro, he was very nice, he did a thorough physical exam and adjusted me. I don’t remember any talk of ‘subluxation’ or ‘innate intelligence’, I remember a very mechanical explanation, the adjustment was comfortable if a little surprising, and GREATLY reduced my pain which remained improved.

            Argument from anecdote
            Post hoc, ergo propter hoc

            2. That was about 15 years ago now. I’ve since seen other Chiro’s for headaches (again, they were a chronic problem that hadn’t resolved on their own) which I had great relief from,

            Argument from anecdote
            Post hoc, ergo Propter Hoc

            3. and now every now ant then if I have a mechanical problem with my body. If you had a machanical problem with your car would you not rather get it fixed than just let it carry on and cause other problems?!

            Begging the question.

            4. I’ve always found them to be very competent, effective, ethical, and a very positive experience from which I get instant and lasting relief.

            Appeal to authority
            Post hoc

            5. I find it very insulting to myself, and other patients who know their own body and own mind, when people insinuate that it’s nothing more than placebo or that it would have got better anyway, and that it’s all ‘quackery’.

            Hasty generalisation
            Special pleading
            Wishful thinking

            6. Really, we’re not that stupid!

            Argumentum ad populum
            Strawman

            7. The Chiropractor has always answered my questions with mechanical and physiological explanations that make a lot of sense. I am practically minded, educated to degree level and run my own business in the conservation sector, so I repeat, I’m really not particularly stupid!

            Appeal to authority
            Dunning-Kruger Effect

            8. Friends and family who’ve followed my advice to ‘just go and see someone’ have also been very happy, and grateful (usually saying to me ‘I should have done this ages ago’) for the treatment.

            Post hoc
            Argumentum ad populum

            9. They are also not stupid people.

            Strawman
            But actually Dunning-Kruger Effect

            10. I find it sad that people who could potentially get help are put off trying something very positive and effective, and fundamentally basic (it’s restricted, lets get it moving, it’s tight, lets relax it), by reviews such as this.

            Causal Oversimplification

            11. Reviews done under the guise of ‘informing potential patients’ but actually just seem to insult and nit-pick, going over the same old thing. Reading through all the comments I feel the Chiropractors have explained themselves well, the critics seem to be just repeating the same questions over and over again even though they have been answered.

            Dunninbg-Kruger

            12. I also find it very bizarre that people (the chiro critics I’m talking about here) can accept that other therapies don’t work for everyone, every time – such as medications, surgery, exercise, etc. – but seem to expect a 100% success rate for Chiropractors/Osteopaths/Acupuncturists/etc??!!

            Strawman + Nirvana Fallacy

            13. The human being is a very complex thing, on many levels, and to expect that one thing will work 100% for every type of case on every type of person with every type of upbringing/lifesyle is a little…. unrealistic?

            Strawman

            14. How about a little balance, kindness

            Appeal to pity

            15. and open-mindedness?

            Ad hominem
            Strawman

            16. After all, the guy who fist had the idea of ‘germs’ – little pathogens that could be transported on our hands – and desperately tried to enforce the washing of hands in hospitals, ended his days in a mental asylum because all his contemporaries thought him mad for his crazy ideas!

            Red herring

            They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown. Carl Sagan

          • January 13, 2013 at 6:32 pm

            Good grief! I didn’t really expect you to…but a good summary!

        • Alan
          January 13, 2013 at 4:31 pm

          What is wrong with this chiropractor is that his method of diagnosis is, at best, a toy and his original diagnosis (an L5 subluxation) is a historical concept. My point being that, based on this one video, you cannot extrapolate your impression to all chiropractors. As I have already said elsewhere, it is the unethical chiropractors who like to hang around in shopping centres, using toys and gadgets to justify unnecessary treatment that should be held to account.

          You make some good points, however I think you have taken literally what was intended to be a light hearted comment on diagnosing back pain by ‘pressing on the sore bit’. You have ignored the part about more thorough examination to stress different joints to more accurately identify the pain producing structure. Nobody thinks they are directly touching a facet joint, the same way nobody thinks that every low back complaint is related to facet joints.

          I also find it interesting that you assume that you could not have a meaningful discussion with a man because of his claims about what happened when his students met Edzard Ernst. This does not make him incapable of discussion.

          • January 13, 2013 at 5:02 pm

            Alan

            How would someone who was looking for a chiropractor know if he/she was one of these ‘ethical’ ones?

            Who do you think should hold the ‘unethical’ ones to account?

          • Badly Shaved Monkey
            January 13, 2013 at 5:40 pm

            Sorry, Alan, as soon as he claimed to have substituted a “biomechanical model” for the subluxation but could not define the former in any meaningful way, I decided that I preferred the ear-bleedingly loud music to exploring the nature of his students’ interactions with Prof Ernst.

            In any case, I don’t feel I have missed out. Here are you lovely chiros to tell us all what you think you do.

      • Badly Shaved Monkey
        January 13, 2013 at 3:53 pm

        P.S. You are welcome to pick up any of the substantive points I made.

      • January 13, 2013 at 4:01 pm

        Alan

        Is the ‘Nervoscope’ a valid diagnostic tool?

        • Alan
          January 13, 2013 at 4:32 pm

          Of course not, even it’s name sounds ridiculous!

          • January 13, 2013 at 5:06 pm

            Alan

            Are the public being misled by a chiropractor who diagnoses using a nervoscope? If so, what is the profession doing to stamp out such unethical practices?

          • January 13, 2013 at 5:09 pm

            http://chirocity.com/nervo-scopenervoscope.aspx

            The Nervo-Scope is used and respected for its efficient, informative and accurate results. These instruments are the most sensitive temperature measurement products available today. All of the competitive products compare themselves to the Nervo-Scope because, after 50 years, it still sets the standard for accurate and reliable results.

            That’s the problem with pseudoscientific alternatives to medicine: there is no mechanism for discarding the obviously batshit insane.

          • January 13, 2013 at 5:16 pm

            WTF? $2,799.99 for a nervo-scope and recorder? Two thermocouples and a moving coil meter? They must have seen chiros coming…

          • January 13, 2013 at 5:18 pm

            Odd that it doesn’t say how accurate it is…

        • John H
          January 13, 2013 at 5:42 pm

          Great video.

          Why is Arnie Schwarzenegger doing backcrackery.

          If I was Justin I am buggered if I would let The Terminator twist my head around and crack my cervical vertebrae. Especially with his knee up my jacksie.

          These Crackoscopes are not exactly cheap are they. No wonder Dr G had to milk Justin for two years. Merely confirms my belief that backcrackery is a self-justifying business and cash is the objective.

          As an EBM comparison a kyphoplasty can offer immediate relief and mobility. It also eliminates the risk of stroke and daylight robbery.

  34. Badly Shaved Monkey
    January 13, 2013 at 3:32 pm

    I had been increasingly interested in exercise and health as a young twenty-something student, and so I liked the sound of giving exercises to patients and lifestyle modification advice. I did some research and found (on a non-chiropractic, non-biased website) that chiropractic seemed to tick all the boxes for me. Spending plenty of time with the patient, being the one in charge of meeting the patient, doing the case history, the examination, taking x rays if necessary, reporting all the findings back to the patient, devising a plan of management and also implementing it! Sounded great to me! (and it is).

    Dr Quack, I am truly sorry that you tied yourself to this fairground shystering profession, but here is the problem in a nutshell. It’s what you now do for a living, so you pretty much need it to defend it. This is the great pity of all the SCAM trades. Many people go into them with good intentions, but head deeper and deeper down the rabbit hole in order to sustain their business no matter how valid the criticism of it. Real doctors pick up and drop therapies and techniques according to the evidence; they continue to offer the best standard of care according to current knowledge. You are a technique.

    • John H
      January 13, 2013 at 5:14 pm

      BSM

      You make a very valid point regarding the dropping of therapies, even when they are properly tested and evaluated.

      It also answers one of the quack comments above regarding Diclofenac. As far as I am aware doctors in the NHS no longer prescribe Diclofenac but prescribe Naproxen instead.

      It makes me think that the alleged “GP” making that comment knows no more about medicine than I do (which may be neatly summarised as bugger all).

      • Dave
        January 14, 2013 at 10:44 am

        “It also answers one of the quack comments above regarding Diclofenac. As far as I am aware doctors in the NHS no longer prescribe Diclofenac but prescribe Naproxen instead.”

        “It makes me think that the alleged “GP” making that comment knows no more about medicine than I do (which may be neatly summarised as bugger all).”

        so your making this comment without evidence and admitting you know bugger all about medicine? Your comments are useless then.

        Diclofenac is still prescribed, thank god your not a GP eh?

        • John H
          January 14, 2013 at 11:40 am

          Dave

          I didn’t make the comment without evidence. I could provide you with a stack of evidence. I merely chose not to.

          Fortunately even though I am not medically qualified I am able to understand the evidence and the statistical methods used to evaluate it.

          My comments are no more useless than those of an MRI operator who is more than capable of using his scanner but probably has very little knowledge of nuclear physics.

          That is why god invented statistics and experimental methodologies.

          For the record your medical qualifications are what exactly.

  35. Badly Shaved Monkey
    January 13, 2013 at 3:50 pm

    I’ve also posted this YouTube previously. Anyone who has not seen a chiro in action should watch it.

    http://www.youtube.com/watch?v=DCLrZBbsGhg

    All the verbiage filling this thread could all too readily conceal the fact of how silly chiropractic is. There are people spending years in colleges to learn how to smack their own wrists.

    It’s a bit like all the effort debating homeopathy and researching its claims when a moment’s thought tells you that to prepare their remedies, homeopaths take a small bottle with something in it then rinse it away multiple times with water. If you rinse out your coffee cup 30 times with water then drink some of the last water you are not going to be bouncing off the ceiling with caffeinated energy. To suggest this would be just silly, but millions of customers are deluded into thinking otherwise every day.

    I have often found that SCAM therapies are their own worst enemies. See what they actually do when shorn of all the rhetorical bullshit. These little emperors are standing butt-naked shrinking their winkies in the cold wind of derision.

  36. Badly Shaved Monkey
    January 13, 2013 at 5:35 pm

    Alan UnHenness

    You now have a pair of related questions to answer. How does one spot a Truly Scottish chiro from one who is batshit insane or a crook? How does one know that the Nervo-Scope is silly but the diagnoses made by your magical fingers are not.

    I’d also like a comment on the demonstration of wrist-slapping in the video I linked to above.

    You may not like Dr NervoScope but the YouTubes of all the chiros that I have watched are similarly hilarious in different ways. No I do not claim this to be an exhaustive survey of every chiro in the world, but I do not find myself able to find one who does not look like a play-acting fool.

    You have access to the YouTubes. Find me a good video to watch.

    Here’s another one I found and the comments I made on it previously;

    http://www.youtube.com/watch?v=Ho2GyA_Iups

    What does WDDTY tell us about that table? The chiro raises the table element then pushes down on the patient and, with an impressive clunk, the table is all lined up again. It does seem a shame to have a patient in the way when you need to adjust your table.

    • John H
      January 13, 2013 at 6:20 pm

      That video frightens me.

      Even the preamble is worrying – the victim talks about being corrected for years. Might he not reasonably expect some improvement (or possibly be slightly curious about what needs so much correction). His bank account is definitely being adjusted.

      Dr Arnie and these two buffoons remind me of the Harry Enfield shop called “I Saw You Coming”

  37. January 13, 2013 at 6:03 pm

    Alan Henness wrote:

    “How would someone who was looking for a chiropractor know if he/she was one of these ‘ethical’ ones?

    Who do you think should hold the ‘unethical’ ones to account?”

    It’s about time the chiropractors posting here answered these serious questions.

    • Dr Quackgood
      January 13, 2013 at 11:58 pm

      I have always told prospective patients to make sure you seek a reputable chiropractor, i.e one who is recommended to you (most patients do this anyway). Key signs to look out for are chiropractors who see more than one patient at a time or have a “high volume” of patients. They typically see a patient every 8 minutes. Watch out for a sales pitch – where you are encouraged to purchase vast amounts of treatments before hand. You should note some change in symptoms by the 4th visit (unless you have a particularly complex case, in which case a plan of management should be discussed, with expected outcomes and rehabilitative factors).

      Unethical practitioners are regularly brought before a conduct committee with the GCC. They are investigated and sentenced accordingly. These cases are published on the GCC website. I do feel that those practices that partake in unethical practice will fail as patients realise the motives behind such practices. However, in a society that provides loans at 3000+% APR, I’m less reassured by the aptitude of the public.

      • January 14, 2013 at 12:15 am

        Dr Quackgood wrote: “I have always told prospective patients to make sure you seek a reputable chiropractor, i.e one who is recommended to you (most patients do this anyway).”

        Recommended by whom?

        Dr Quackgood wrote: “Key signs to look out for are chiropractors who see more than one patient at a time or have a “high volume” of patients. They typically see a patient every 8 minutes. Watch out for a sales pitch – where you are encouraged to purchase vast amounts of treatments before hand. You should note some change in symptoms by the 4th visit (unless you have a particularly complex case, in which case a plan of management should be discussed, with expected outcomes and rehabilitative factors)”.

        That’s as useless as the GCC’s answer to question 4 here:
        http://www.gcc-uk.org/page.cfm?page_id=6

        Dr Quackgood wrote: “Unethical practitioners are regularly brought before a conduct committee with the GCC. They are investigated and sentenced accordingly.”

        Regularly? I think not. For example, the several hundred UK chiropractors who form the Alliance for UK Chiropractors haven’t been called to account for their unscientific practices.

        Dr Quackgood wrote: “These cases are published on the GCC website. I do feel that those practices that partake in unethical practice will fail as patients realise the motives behind such practices.”

        Why aren’t *all* those practices being stopped by the GCC right now? Is the GCC currently unaware of their “motives”?

        • Badly Shaved Monkey
          January 14, 2013 at 7:51 am

          I see that Dr Quackgood has displayed the usual frustrating behaviour of SCAMster posters here and has left this line of argument dangling while he tells us all about AC Milan.

  38. January 13, 2013 at 6:04 pm

    I wonder what the precedent is for withdrawal of a Royal warrant? I imagine it will not be especially hard to put together evidence that members of the the Royal College of Manipulative Quacks are engaged in unethical practices, and past experience also indicates that the RCMQ itself will to the square root of fuck all about that. A nice embarrassing scandal would be good.

  39. Marc Stephens Is Insane
    January 13, 2013 at 7:37 pm

    I’m always amused when supporters of dubious medical practices cite athletes as believers. As has been mentioned above, athletes are the most superstitious performers out there. If an athlete has a good day on the field after having worn green socks that morning, that athlete will make sure he only wears green socks every game day from that point on.

    A very popular NHL hockey goalie here endorses a Boiron homeopathic cold product. Another hocket team once had all their players sit under pyramids in the dressing room to “draw energy” and hopefully improve their game (it didn’t work–they lost the playoffs that year). Many players cross themselves as they step on the playing field or ice surface and thank a god in post-game interviews. A well-known British snooker player endorses Gerson cancer quackery.

    Who cares what athletes believe?

    • Dr Quackgood
      January 13, 2013 at 11:10 pm

      Perhaps you should ask the share holders of AC Milan football club who entrust the position of the head of medical facility to a chiropractor? Go pay them a visit, you might bloody learn something about injury prevention.

      • January 13, 2013 at 11:46 pm

        Dr Quackgood wrote: “Perhaps you should ask the share holders of AC Milan football club who entrust the position of the head of medical facility to a chiropractor? Go pay them a visit, you might bloody learn something about injury prevention.”

        We might also learn about quackery. Wasn’t that entrusted chiropractor, J. P. Meeserman, a member of the panel that developed the WHO Guidelines on Basic Training and Safety in Chiropractic? Section 1.2 of the guidelines is quite revealing:

        Quote:
        “The concepts and principles that distinguish and differentiate the philosophy of chiropractic from other health care professions are of major significance to most chiropractors and strongly influence their attitude and approach towards health care. A majority of practitioners within the profession would maintain that the philosophy of chiropractic includes, but is not limited to, concepts of holism, vitalism, naturalism, conservatism, critical rationalism, humanism and ethics (9).”

        Link: http://www.chiroeco.com/50/bonus/WHOguidelines.pdf

        Apparently Meeserman implemented a non-medical, chiropractic approach for AC Milan just after he was appointed. But would we have seen any difference in the team if he had handed each player a lucky rabbit’s foot instead? IOW, can you prove that any improvement in the team was due to his philosophy?

  40. Marc Stephens Is Insane
    January 13, 2013 at 7:57 pm

    It also seems that every chiro I’ve encountered, either in real life or on websites, is involved with other forms of cross-woo that they of course sell, like TFT, cranial-sack-of-shit therapy, supplements, homeopathy, flower remedies, crystal healing, naturopathy, etc. Anything to boost the bottom line. Once you have a sucker in your examination room you might as well try to upsell him a few bottles of pills or some useless new age voodoo.

  41. Badly Shaved Monkey
    January 13, 2013 at 8:26 pm

    Come on, chiros. Lots to be getting on with. Or this silence the sound of quacks ducking?

  42. Marc Stephens Is Insane
    January 13, 2013 at 8:48 pm

    Chiros also seem to have warped views on diesase and cancer treatment. Several “DCs” appear prominently on websites selling Ryke Hamer’s German New (Non) Medicine and the spinoff Biologie Totale, as well as Gerson’s quackery, vitamin detox regimes (i.e. scientology’s sauna purification) and others. It seems every website I find endorsing quack healthcare, anything with the words “wellness” or “healing” or “holistic,” there’s a DC involved. Usually using the title “Dr.” for phony credibility. If DCs can believe such farfetched non-scientific garbage I don’t want one touching my spine.

  43. Marc Stephens Is Insane
    January 13, 2013 at 8:53 pm

    RE: Gerson DCs.

    Here’s the first one (of dozens) I found online. Does a guy like this give other chiros a bad name? Are they embarrassed that a guy like this is in the same profession as they are?

    http://www.dolphindoctor.org/

    What gives a DC the right to treat anyone for cancer? Especially quackery like Gerson?

    Trust me: there are hundreds of people like this out there.

  44. Marc Stephens Is Insane
    January 13, 2013 at 9:13 pm

    Here’s another deluded cancer-treating DC who practices “pastoral medicine” (i.e. praying), “Dr.” Kevin Conners. He sells the Gerson garbage and supports Rife, Hoxsey,laetrile, Burzyski, Budwig, essiac and Protocell. Wonder what he has against Hulda Clark?

    Why is this quack treating cancer patients? Chiros, you must be so proud…

    http://upperroomwellness.com/custom_content/c_69990_cancer__alternative_care.html

  45. Dr Quackgood
    January 13, 2013 at 11:31 pm

    You have cited two American chiropractors, who quite clearly represent the fringe of a profession. This is by no means a reflection on UK chiropractic which is the position we are here to defend. Regrettably, our profession follows a different line in the US, where schools of chiropractic are notorious for indoctrinated chiropractic philosophy (Sherman college of straight chiropractic for example). We who hold highly accredited Masters degrees resent these teachings and are powerless to amend them. All we can do is regulate the profession within Europe and set a president for chiropractic practice, as is done by the College of Chiropractors and the GCC.

    What I will say to defend some of the therapies you have mentioned, Gerson for one, is that they promote nothing more than healthy lifestyle choices. I can see only benefit to be gotten from consuming high quality nutritional food, cancer or no cancer. Or do we have to wait until the patient’s teeth are falling out to prescribe fresh fruit juice? Do not be so quick as to lambaste patients who make healthy lifestyle choices, you might just end up with an obesity epidemic.

    • January 14, 2013 at 12:02 am

      Dr Quackgood wrote: “This is by no means a reflection on UK chiropractic which is the position we are here to defend…All we can do is regulate the profession within Europe and set a president [sic] for chiropractic practice, as is done by the College of Chiropractors and the GCC.”

      In view of the utterly shambolic state of affairs that the GCC and the College of Chiropractors have produced, do you really think that regulating more of the profession within Europe is a wise idea? I invite readers (not least evidence-based health professionals and investigative journalists) to put aside some time to read what’s been going in the UK:
      http://www.ebm-first.com/chiropractic/uk-chiropractic-issues.html

    • January 14, 2013 at 12:02 am

      Dr Quackgood: I’ll ask you the question I asked you earlier:

      When do you believe the subluxation was last taught to chiro students in the UK other than as an historic concept?

    • Marc Stephens Is Insane
      January 14, 2013 at 12:25 am

      You know nothing about Gerson if you think it’s only about eating fruits and veggies and can cause no harm. It involves multiple coffee enemas daily, plus literally hundreds of supplement pills a day. Gerson customers are encouraged to give up all their traditional (i.e. REAL) medicine in favour of the Gerson regime.

      The fact you think it’s OK just reinforces why I believe chiros have a warped view of health care. Real health care; not cracking backs.

      And why is a chiro treating cancer in the first place?

      • Mojo
        January 14, 2013 at 10:02 am

        The comment, “Or do we have to wait until the patient’s teeth are falling out to prescribe fresh fruit juice” also betrays a remarkable degree of ignorance about medicine. Does he seriously imagine that cancer patients are not advised, and assisted, to eat a balanced diet (or at least, as balanced as they are able).

        That, or Dr Quackgood is attacking a strawman wrapped up in a false dilemma.

        • Marc Stephens Is Insane
          January 14, 2013 at 10:13 am

          Ironically, fruit juice is a nutritional pariah these days, as it is one of the biggest contributors to tooth decay. It contains as much sugar as soft drinks and almost none of the nutrition of the whole fruit. And many many people are on drugs that proscribe grapefruit juice, for example. Most hospitals ban grapefruit juice altogether to prevent drug interactions.

  46. Marc Stephens Is Insane
    January 14, 2013 at 12:59 am

    Dr. Quackwood,

    How on earth can having a chiro on hand at a football match prevent injury?

    And yes, of course it will be easier to find chiroquacks who “treat” cancer in North America. You have the Cancer Act which prevents such garbage from being advertised. But I’m sure there are plenty of chiros in the UK, just like there are plenty of homeopaths who claim they treat cancer. It’s just more hush hush “nudge nudge wink wink” by law.

    The main point is the mentality of chiros leads them to ally themselves with other forms of woo. Whether that’s Gerson, or Bodytalk, or EFT, or crystals it is defintely true. It’s like chiros want the “alternative” or new age cachet to lure in those disillusioned by mainstream medicine, or not trusting of mainstream medicine. And yet the chiros also desperately want to be considered part of the medical mainstream.

  47. Dr Quackgood
    January 14, 2013 at 2:01 am

    Ok younger learn a lot more than I imagined. Prevention is about what you take into the game, not reacting to events during the game. Players (patients) are profiled for muscle inhibition and weaknesses in proprioception. This is because reflexive control will determine whether a player stabilises his knee joint, for example, or sustains tissue damage by unresisted forces (no not Jedi mind forces, Newtonian forces). By identifying where a player/patient is deficient in this way, treatment or training methods optimise the players ability to resist forces and perform his role at a higher limit than would be expected otherwise. The results speak for themselves, ACMilan has the lowest rate of injury and the fittest players. Other professionals like Kim Klijsters have gone to use their facility, and more clubs are adopting this method – simply because injury is too expensive.

    We just want to be recognised for what we are. A serious primary care practice at the forefront of noninvasive musculoskeletal medicine.

    I haven’t researched this question, but I would say that chiro philosophy was last taught other than history towards the end of the 80s, in the UK.

    • January 14, 2013 at 9:01 am

      Dr Quackgood wrote: “I haven’t researched this question, but I would say that chiro philosophy was last taught other than history towards the end of the 80s, in the UK.”

      If that’s true then why does the GCC’s Fitness To Practice Report 2007 say “The GCC’s expert witness advised that the discovery of subluxations (areas of vertebral restriction in the spinal joints) is commonplace to the point of universality in patients”?

      See the foot of p.15 of this pdf:
      http://www.gcc-uk.org/files/link_file/FITNESS_TO_PRACTISE_REPORT_2007_FINAL_FOR_WEBSITE.pdf

      Further, although it has now changed the content of its website, less than four years ago the ‘Objectives’ section of the McTimoney Chiropractic Association stated the following:

      Quote
      “By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements)”.

      The above does not suggest to me that chiropractic philosophy has been taught as history only since the end of the 80s.

      • Dr Quackgood
        January 14, 2013 at 12:14 pm

        Firstly, the foot of page 15 on the link provided does not refer to what you are alluding to. It is a 12 month suspension order for Dr Vatsadze for practicing without valid registration.

        Regarding the quote “The GCC’s expert witness advised that the discovery of subluxations (areas of vertebral restriction in the spinal joints) is commonplace to the point of universality in patients”
        May I repeat myself in distinguishing between a term used to describe a dysfunctional motion segment (prevalent in most people who are sedentary) and a historic pseudoscientific claim that a blockage in the spine leads to a decrease in innate intelligence. Again, I make the comparison with the word hysterectomy – still used to describe the surgical removal of the uterus (complete or partial) and the origin of this word for the treatment of hysteria. You could no more fault a surgeon for using the word hysterectomy than a chiropractor for using the word subluxation, given the context.

        Quite clearly from the quote you provided, the McTimony chiropractors follow their own discourse and should (and have been) reprimanded as such.

        For a more accurate answer to the question of chiropractic history, perhaps consult early graduates of institutions, or heads of department.

        • January 14, 2013 at 12:40 pm

          Dr Quackgood wrote: “Firstly, the foot of page 15 on the link provided does not refer to what you are alluding to. It is a 12 month suspension order for Dr Vatsadze for practicing without valid registration.”

          Please note that I said it was on page 15 *of the pdf*. (It’s on page 13 on the original document.)

          Dr Quackgood wrote: “Regarding the quote “The GCC’s expert witness advised that the discovery of subluxations (areas of vertebral restriction in the spinal joints) is commonplace to the point of universality in patients” May I repeat myself in distinguishing between a term used to describe a dysfunctional motion segment (prevalent in most people who are sedentary) and a historic pseudoscientific claim that a blockage in the spine leads to a decrease in innate intelligence.”

          But it’s not distinguishable at all. That’s the problem. The term is being abused by the many UK subluxation-based ‘philosopher’ chiropractors – IOW, it allows them to scam unwitting patients.

          Dr Quackgood wrote: “Quite clearly from the quote you provided, the McTimony chiropractors follow their own discourse and should (and have been) reprimanded as such.”

          As already highlighted, many of the McTimoney chiropractors are members of the Alliance of UK chiropractors. Why haven’t their – and the rest of the AUKC’s – pseudoscientific practices been outlawed by the GCC?

    • Dr Richard Rawlins
      January 14, 2013 at 10:28 am

      Now we’re at the nub of it.

      You claim to be, and/or want to be in “a primary care practice at the front of medicine”.

      I call folks who practice primary care medicine “doctors.”

      So, if you want to be a doctor, why not qualify as one? And all this nonsense will melt away.

      • Dr Quackgood
        January 14, 2013 at 11:18 am

        Or dentists. Or podiatrists. Or dieticians? Or psychologists. Occupational therapists? Mid wives. Paramedics? Pharmacists? It’s not just someone who holds an MD that can provide primary healthcare Dr Rawlins. I cannot deny that I wouldn’t benefit from holding an MD, but most likely I would be repeating myself, as much of the syllabus of MChiro overlaps with MD. This has been demonstrated, and I would be willing to demonstrate the depth and breadth of my knowledge if questioned (except for pharmacology, which is not covered, for obvious reasons).

        What you’re also suggesting that medical doctors are free to act as they please. Heaven forbid that a GP perform spinal manipulation. It takes years to master this skill. Countless hours of practice and honing a psychomotor skill. I would no more trust a butcher to perform an appendectomy and expect to live. As I’m sure a surgeon as prestigious as yourself would agree, you take great pride in your abilities. So do we. I urge you to visit my clinic and engage in what I do. Surely I cannot hide any insecurities then?

        Please be careful not to misquote me. I said “at the forefront of noninvasive musculoskeletal medicine”. You make it sound as though I imply we are pioneers in general medicine, which we are not.

        • January 14, 2013 at 12:13 pm

          Dr Quackgood wrote: “Heaven forbid that a GP perform spinal manipulation. It takes years to master this skill.”

          Oh? Here’s what Edward Rothman, DC, a senior lecturer at the UK’s Anglo European College of Chiropractic, had to say not so long ago about chiropractic manipulative therapy…

          Quote:
          “…it is my perception that there are very few rational chiropractors willing to leave, what I have termed, the ritual induced placebo of our manipulative techniques, the monotherapeutic nature of the profession, and the unethical practice building…I am an American currently working at a chiropractic school in England. For me, AECC has been a little utopia because of the talented and dedicated people I work with. However, in the four years I have been in England, I have seen a change come over the profession there as more and more people take on American practice building methods and are attracted to irrational, illogical techniques and treatment pursuits, e.g., “occipito-sacral decompression in chiropractic paediatrics” (don’t even try to understand that one).”

          Link: http://tinyurl.com/32l9o5e

          So, it takes years to master a ritual induced placebo?

          • Dr Quackgood
            January 14, 2013 at 12:55 pm

            You are very good at misquoting people Mr Wode! In this monologue, Edward Rothman was lamenting about “wacky technique gurus, DCs with fake PhDs, sleazy practice builders, and ridiculous “diagnostic” methodologies (subluxation station, sEMG
            scanning)” from the States. It is these people that he describes having “ritual induced placebo of our manipulative techniques, the monotherapeutic nature of the profession, and the unethical practice building”

            He acknowledges these individuals as what they are, and observes more and more of their strategies being used in the UK.

            “in the four years I have been in England, I have seen a change come over the profession there as more and more people take on American practice building methods and are attracted to irrational, illogical techniques and treatment pursuits.”

            I agree with him. But this is not the chiropractic we represent. This is imported bullshit in a nature of get rich quick american dreams.

            Edward Rothman expresses his dispair in the same monologue “Some of us can ban together and discuss these issues but will chiropractic/chiropractors ever
            change? What hope do we have of making the radical changes to the profession that is needed to attract rational scientific people into the field, considering the general state of the profession and the historical and current stance of the ACA?”

            It is the rational scientific people in the field of chiropractic that are here to make the stand and represent what has been said on this comment thread.

            So when I talk about the mastery of manipulation, I’m not talking about snap crackle and pop practices Mr Wode. I am talking about the application of manual thrust at the right place at the right time to a mechanical lesion, as determined by a thorough case history and examination.

        • Dr Richard Rawlins
          January 14, 2013 at 3:39 pm

          Dr Quackgood,

          I have not misquoted you.

          You restate that you said “at the forefront of …medicine”

          In the English language, adjectives such as “noninvasive” and musculoskeletal” do not alter the sense of the noun they describe. In this case “medicine”.

          You could have said “…therapy”, but you didn’t. You said, and repeated, “medicine.”

          There has been no mention of “pioneers”. I do not know where you got that from.

          Now you use the old straw man switch and imply I was refering to “healthcare” – when I specifically took you up on your point that you claimed to be at the forefront of “medicine”.

          I’m sorry to disappoint you, but there is no curriculum for an UK MD, nor MS, MCh. They are higher degrees awarded by a university after examination on an original thesis following research carried out under the supervision of a professor.

          And yes, a GP can carry out a manipulation, (I am only quoting Bronfort)but at all times has to act within his/her sphere of competence. So obviously they would have to learn the techniques. But that does not ammount to professing any sort of special insight or arcane knowledge about the nature of disease and the ability of unblocked ‘innate’ to affect somatic organs and tissues.

          I am still unclear why you did not, or do not, become a doctor. Then the world would be your oyster.

          Or why you did not spend three years qualifying as a physiotherapist, and then two more specialising in various manipulative techniques.

          Unless of course you subscribe to a philosophical world view and metaphysical construct which is an alternative to those of science-based healthcare professions.Which we have developed since the Enlightenment.

          Should you wish to take this thread further, please explain in what way the practice of physiotherapy differs from chiropractice. Please do not say “we use short amplitude adjustments”. Any physiotherapist, or doctor, could in time learn them. So what is the fundamental difference?

          Until that can be explained chiropractic will remain an alternative for folks who like that sort of therapy.

          Fine. That’s OK. Get on with it.

          But please do not confuse it with “medicine”.

  48. Badly Shaved Monkey
    January 14, 2013 at 7:47 am

    Dr Quackgood

    Is the ‘Nervoscope’ a valid diagnostic tool?

    Comment on the wrist–slapping YouTube that I posted.

    There’s also nothing stopping you addressing any of the other questions that have been left dangling by our hit-and-run chiro posters.

    The results speak for themselves,

    Let’s test your ability to assess evidence. Why might the results not speak for themselves? I would expect someone in serious primary care practice at the forefront of noninvasive musculoskeletal medicine to be able to show an understanding of what constitutes valid evidence.

    • Dr Quackgood
      January 14, 2013 at 11:43 am

      The nervoscope is a thermocouple with a dial showing temperature difference left and right.
      It is no more diagnostic than a thermometer is. What it does show are temperature differences on either side of the midline. Temperature elevation is a fundamental sign of inflammation (rubor, tumor, dolor, calor, functio lasae). It doesn’t tell a clinician what the problem is, only that there is a temperature difference left and right. These instruments are part of a chiropractic technique called Gonstead. I find these instruments unreliable and outdated, and I would question the rationale of any chiropractor using only this tool in primary diagnosis. Needless to say I don’t use one as I’m more concerned with functional change than localised inflammatory responses.

      I will get back to your question regarding valid evidence when I have the time a question such as this deserves (by the end of today).

      • January 14, 2013 at 1:35 pm

        It’s two thermocouples, but let’s not quibble.

        Inflammation may cause a localised temperature increase, but so might other factors. But if it is so unreliable and outdated, why do so many chiros still seem to be relying on it? Do you think there is a place for a regulator to ensure the public are protected form unreliable methods?

        • Dr Quackgood
          January 14, 2013 at 2:29 pm

          Yes sorry, two thermocouples. You’re quite right.

          There are, as you rightly point out, many reasons for localised temperature increase, which adds to this device’s unreliability. I don’t use it, we’re not taught to use it at university and the only chiropractors I know who use it are from America or do not rely solely on it for identifying a manipulable lesion.

          Yes, I think there is a great need to regulate, or somewhat homogenise, chiropractic practice. The main issue here is that the GCC does not define a scope of practice, only the qualification and conduct of the practitioner. This makes it difficult to police who is practicing what and how. Then of course you have the egos within the profession itself. Who will decide what technique is the best etc. For the moment it is an impossible situation as Blue Wode has correctly pointed out. Our stance, that of my peers, is a system of peer review. We all communicate what we observe to be the most effective treatment strategy within our professional tool box. For example, an alumni is in place where chiropractors can post queries about difficult cases they are presented with, and help is provided from other practitioner’s clinical experience.

          The university programs are producing excellent clinicians who are versed in patient centred care. Post graduate training is also encouraged by the College of Chiropractors and of course annual CPD is mandatory for registration. I think footholds are in place to protect the public as much as possible. I think there is a long way to go, but it all begins with educating the public, which is why we post on comment threads such as these.

          • Alan Henness (aka Zeno)
            January 14, 2013 at 2:58 pm

            Dr Quackgood said:

            The main issue here is that the GCC does not define a scope of practice, only the qualification and conduct of the practitioner. This makes it difficult to police who is practicing what and how.

            No, it’s very easy, but one step they seem unwilling to take. The GCC regulates training courses: they could very easily refuse to recognise any training that teaches bogus techniques. The GCC state:

            The GCC promotes high standards of chiropractic education and training to ensure that students, upon graduation, can meet the requirements of the GCC’s Code of Practice and Standard of Proficiency. The Code and Standard set out for patients the quality of care they are entitled to receive from chiropractors. For chiropractors they are the benchmarks of conduct and practice. (Source)

            If chiros are being taught bogus techniques and the GCC allow this, and they aiding and abetting the breach of their CoP and failing to protect the public. All the regulator is doing then is protecting its registrants.

            Then of course you have the egos within the profession itself. Who will decide what technique is the best etc.

            Again, very easy. Let the robust scientific evidence decide, not the whims of egos, no matter how massive..

  49. January 14, 2013 at 1:39 pm

    Dr Quackgood wrote on January 14, 2013 at 12:55 pm: “I agree with him [Edward Rothman]. But this is not the chiropractic we represent. This is imported bullshit in a nature of get rich quick american dreams.”

    It is irrelevant that you don’t represent “imported bullshit”. The fact that many chiropractors in the UK do serves only to illustrate that the General Chiropractic Council is failing greatly in its prime duty to protect the public.

    Dr Quackgood wrote: “So when I talk about the mastery of manipulation, I’m not talking about snap crackle and pop practices Mr Wode. I am talking about the application of manual thrust at the right place at the right time to a mechanical lesion, as determined by a thorough case history and examination.”

    Hmm…

    “This study of commonly used chiropractic diagnostic methods in patients with chronic mechanical low-back pain to detect manipulable lesions in the lower thoracic spine, lumbar spine, and the sacroiliac joints has revealed that the measures are not reproducible. The implementation of these examination techniques alone should not be seen by practitioners to provide reliable information concerning where to direct a manipulative procedure in patients with chronic mechanical low-back pain.”

    http://www.ncbi.nlm.nih.gov/pubmed/10820295?dopt=Abstract

    Seems to me that what you perform is more a general laying on of hands than any refined technique the elicits a specific effect.

    • January 14, 2013 at 1:41 pm

      @ Dr Quackgood

      In support of my previous comment, it’s worth remembering that academics David Byfield, Susan King, and Peter McCarthy of the Welsh Institute of Chiropractic at the University of Glamorgan claimed that it had been shown that

      “patients are very pleased and satisfied with chiropractic care whether they get better or not”

      http://web.archive.org/web/20041215180456/www.familychiropractic.co.uk/news/Articles/article3.htm

      • John H
        January 14, 2013 at 3:52 pm

        So are heroin addicts.

    • Dr Quackgood
      January 14, 2013 at 3:14 pm

      Perhaps you should ask your partner how they appreciate your general laying on of hands rather than a refined technique…

      And now suddenly it’s ok for you to reference JMPT? When it suits you? Suddenly Cochrane database isn’t your gold standard? We know the inter reliability is crap. Intra reliability isn’t. I know that if I aggravate a problem, the patient will get worse. If I push a light switch the wrong way, it doesnt matter how many times I do it the light wont go on. If I correct a problem the patient does get better. I get messages like “Big improvement after my last visit. I still have the problem but at 25% of when I saw you. It def made a difference. I ran last night for 40 mins, the second 20 was easier on my back and it loosened up a bit. Still further recovery needed but that will hopefully happen over the next few days. Will keep you updated. Cheers” I saw him twice. This guy runs one of the largest investment companies in the world. I’d hate to insult his intelligence by telling him he thought himself better.

      I know you dont accept anecdotes, but I do. My day is a series of anecdotes that rely on my profession to get them back on their feet. Those anecdotes are what send me more anecdotes and their anecdotal friends and anecdotal colleagues. So forgive me for not jumping on your band wagon of treating patients as lab rats. They deserve far more respect than you give them credit for.

      • January 14, 2013 at 3:40 pm

        Dr Quacgood said:

        I know you dont accept anecdotes, but I do.

        Ah. The nub of the problem.

      • January 14, 2013 at 3:42 pm

        Dr Quackgood wrote: “If I correct a problem the patient does get better.”

        How do you know that you’ve “corrected” a problem and that it’s not other factors which are producing positive outcomes?

        I’m talking about self-serving biases and demand characteristics (e.g. the customer is unwilling to admit to having experienced poor outcomes if a great deal of time and money has been invested); the possibility that the condition may have run its natural course (i.e. self-limiting or cyclical ailments regressing to the mean); spontaneous remission; the placebo effect (enhanced by touch); the possibility that some allegedly cured or relieved symptoms were probably psychosomatic to begin with; and misdiagnosis.

        • Mojo
          January 14, 2013 at 10:10 pm

          Dr Quackgood wrote: “If I correct a problem the patient does get better.”

          How do you know that you’ve “corrected” a problem…

          Because the patient gets better. ;)

          • Badly Shaved Monkey
            January 14, 2013 at 10:19 pm

            Ooh, circly.

  50. Badly Shaved Monkey
    January 14, 2013 at 6:07 pm

    Dr Quackgood,

    Please show that you have some understanding of how to assess evidence. I am also a clinician and do this on a daily basis. I am well aware of the problem of cognitive biases. The difference is that I recognise their dangers and try to accept the limitations they place on the reliability of what we do. You seem to revel in them.

    We know the inter reliability is crap. Intra reliability isn’t.

    You’ve already said this and you’ve said it again as if it’s a good thing. It is not. Why might the absence of inter-operator reliability completely undermine your activities regardless of your intra-operator reliability.

    I know you dont accept anecdotes, but I do.

    Try to show some understanding of where we are coming from. Why don’t we acceot anecdotes?

    • Andy Lewis
      January 18, 2013 at 11:01 am

      Yes, footballers can fall for chiropractors talk too!

  51. Badly Shaved Monkey
    January 18, 2013 at 8:31 pm

    Have the chiros left us for good?

    • Chris
      January 18, 2013 at 9:28 pm

      Yep I think the chiros have had enough. Its not worth the effort to keep repeating the same arguments to people who can’t accept that the profession is changing for the better. It’s frankly insulting to what modern chiropractors train to become, believe in and stand for. You can stay in your stubborn, surreal, research enduced coma if you like. We will continue to do something worthwhile and meaningful – change patients lives for the better. They are the ones who matter, and because of the work we do chiropractic continues to thrive, despite your blatant agenda and vitriol.

      • January 18, 2013 at 11:04 pm

        Why, after 100-odd years, isn’t there a substantial and compelling body of robust research evidence for chiropractic?

  52. January 18, 2013 at 10:27 pm

    Chris wrote: “You can stay in your stubborn, surreal, research enduced [sic] coma if you like. We will continue to do something worthwhile and meaningful – change patients lives for the better. They are the ones who matter, and because of the work we do chiropractic continues to thrive, despite your blatant agenda and vitriol.”

    How long chiropractic will last is debatable. Chiropractic has owed its very slow growth largely to relentless marketing and political lobbying. In other words, chiropractors have managed to dupe legislators and the public, both of whom are generally not well-versed in scientific matters. However, chiropractic’s future is not looking as bright as you might think. For example, in the USA, there was a 39% drop in chiropractic education student enrolment in the US from 1969-2002, and while the use of CAM in general has increased there, the largest decrease has occurred for chiropractic – 9.9% down to 7.4% (and I understand that it’s still falling).

    I would draw your attention to Scenario 2 on p.64 of this pdf (p.50 of the actual document) which, IMO, describes where chiropractors are heading:

    The Future of Chiropractic Revisited: 2005 to 2015
    http://www.altfutures.com/pubs/health/Future%20of%20Chiropractic%20Revisted%20v1.pdf

    What makes you think that the future of chiropractors in the UK will be different from that?

    • Chris
      January 19, 2013 at 12:02 am

      As I said “stubborn, surreal, research INDUCED coma” ;-)

      Yet again the same old questions and rhetoric. It’s interesting how you seem to always reference the US – a model of chiropractic that is largely disconnected with the uk profession and public opinion.

      Try getting out into the real world. Patients are disillusioned with the nhs model of patient care and are increasingly turning to alternatives. I see it every day and the way things are going it will continue. I care about my patients getting better, despite what you say. But I guess you’ve nothing better to do. Enjoy your crusade, I hope it makes you feel as good as I do when I change someone’s life for the better.

      • January 19, 2013 at 5:57 am

        Chris wrote: “It’s interesting how you seem to always reference the US – a model of chiropractic that is largely disconnected with the uk profession and public opinion.”

        The US model is not “largely disconnected” with the UK profession. As already illustrated, many UK chiropractors adhere to original chiropractic theory (some while pretending to have abandoned it). At the same time, a minority are scratching around in desperation for good evidence because they’ve seen the writing on the wall. As for public opinion, it is irrelevant to this discussion. What we’re interested in is scientific data.

        • Chris
          January 19, 2013 at 10:44 am

          “As for public opinion, it is irrelevant to this discussion. What we’re interested in is scientific data.”

          Really? That’s strange. The attention grabbing article title and typical out-dated anti-chiropractic diatribe that follows seems specifically targeted to stir up public opinion.

          • January 19, 2013 at 12:33 pm

            Chris wrote: “The attention grabbing article title and typical out-dated anti-chiropractic diatribe that follows seems specifically targeted to stir up public opinion.”

            The current discussion is about the future of chiropractic, the security of which lies ultimately with its evidence base – i.e. Scenario 2 described in ‘The Future of Chiropractic Revisited: 2005 to 2015’:

            Quote [my comments in brackets]

            The cost squeeze in healthcare pushes many chiropractors to the brink. Consumer demand falls and managed care removes even more chiropractic coverage from their plans. [Already happening in the UK – insurance companies are further limiting numbers of visits to chiropractors, and many GPs will not refer to chiropractors because of the controversy surrounding it.]

            Standards of care fall, insurance fraud is common, and many chiropractors turn to unethical behavior to sustain their practices. [Evidently true, for the most part. Chiropractic quackery is rife in the UK, but the GCC appears to turn a blind eye to it.]

            Simultaneously, serious malpractice cases involving missed and ignored diagnosis of serious illnesses by super straight chiropractors become major media stories. [Becoming increasingly common in the international press, especially where chiropractors have failed to recognise patients' VBA dissection symptoms.]

            By 2015, the evidence base for chiropractic effectiveness advances little over the limited indications where chiropractors had been proven effective in 2005. [Already happening – Ref. Cochrane Reviews.]

            Other providers offer spinal manipulation for lower back, neck, and chronic pain. DPTs and massage therapists take over a large percentage of
            the cash market for back pain. The remaining chiropractors fight over the declining number of “true believer” patients who have had positive previous experiences with chiropractic and can afford to pay out-of-pocket. [This is what is likely to happen in the UK as healthcare becomes increasingly privatised.]

            http://www.altfutures.com/pubs/health/Future%20of%20Chiropractic%20Revisted%20v1.pdf

          • Chris
            January 19, 2013 at 1:40 pm

            “The current discussion is about the future of chiropractic”

            How convenient.

            And yet again you quote a US study…

            The UK health industry is a totally different animal to the states. One in which the nhs is systematically and slowly killing off any faith people may have in the medical profession.

  53. January 19, 2013 at 1:50 pm

    @ Chris

    The UK health industry is set to adopt much of the US model, and in the US chiropractic is experiencing a gradual demise. What makes you think that chiropractic in the UK will be any different from the US in the years ahead, especially when you consider that chiropractic’s accepted scientific evidence base is the equivalent to taking two paracetamol?

    • Chris
      January 19, 2013 at 2:37 pm

      Well of course we must blindly copy the US health model exactly then – and all of its mistakes. The US care system is well regarded as one if the most unbalanced, corrupt and inefficient models in the world.

      I’d like to think that the UK profession will learn from the errors of the US. This is already well underway with the process of proposed revalidation and regular contributions to a newly established chiropractic research body. It’s still a growing and evolving system. The “quacks” that you recognise will gradually be hounded out of the profession.

      And the “accepted scientific evidence base” of the comparison with two paracetamol is certainly not accepted by the people I see. REAL people. In pain and usually having been given paracetamol and pain killers for years and told to “learn to live with it”. Try telling them that chiropractic and the lifestyle changes we advocate doesn’t work. Because I can tell you now that in the majority of cases it does.

  54. Dr Richard Rawlins
    January 19, 2013 at 3:24 pm

    Please do not confuse lifestyle advice and back manipulation with “chiropractic2.

    We all know what chiropractic is. It is an alternative to the medicine and therapies offered by GMC doctors and HPC registrants.

    Nothing wrong with that, providing the patient gives fully informed consent – and the practitioner is not confused about their practice.

    • Chris
      January 19, 2013 at 3:36 pm

      You are correct I that it is an alternative to the medical Ppr Chiropractic is much more than just spinal manipulation – or at least it should be. It’s about ergonomics, diet, core strengthening, balance and lifestyle advice. In fact anything that identifies and improves the quality of life of the patient and the CAUSE of the original complaint.

      It’s not just a technique and a philosophy. It’s about patient care and its a shame

    • Chris
      January 19, 2013 at 3:45 pm

      You are correct in that it is an alternative to the medical approach. And that’s a good thing. Chiropractic is much more than just spinal manipulation and an outdated philosophy – or at least it should be. It’s about ergonomics, diet, core strengthening, balance and lifestyle advice. In fact anything that improves the quality of life of the patient and identifies the CAUSE of the original complaint.

      Its a shame more GPs and medics don’t encompass this approach, instead of incessantly fobbing patients off with painkillers. It would save billions of pounds.

      Don’t get me wrong, not all medics are like this and I appreciate the political pressures and time constraints involved. There are some bloody good GPs and consultants out there – I know because I treat some of them :-)

  55. Chris
    January 19, 2013 at 3:46 pm

    Bloody iphone ;-)

  56. Dr Richard Rawlins
    January 19, 2013 at 4:28 pm

    I’d get it adjusted if I were you!

  57. January 19, 2013 at 5:00 pm

    Chris wrote: “I’d like to think that the UK profession will learn from the errors of the US. This is already well underway with the process of proposed revalidation and regular contributions to a newly established chiropractic research body. It’s still a growing and evolving system.”

    Growing and evolving? It’s been a 100 years. How long does a profession with such a narrow field need? It’ll be interesting to see if these latest undertakings ever add anything of real value to MSK healthcare or if they’re just another façade in chiropractic’s ongoing clamour for respectability.

    Chris wrote: “The “quacks” that you recognise will gradually be hounded out of the profession.”

    Why “gradually”? What was it that stopped the GCC from eradicating the large quack element from the profession when the statutory regulation of chiropractors in the UK came into force 12 years ago?

    Chris wrote: “And the “accepted scientific evidence base” of the comparison with two paracetamol is certainly not accepted by the people I see. REAL people. In pain and usually having been given paracetamol and pain killers for years and told to “learn to live with it”. Try telling them that chiropractic and the lifestyle changes we advocate doesn’t work. Because I can tell you now that in the majority of cases it does.”

    We’ve already been over why the people you see are inclined to think that chiropractic works. I would remind you that you seem to ignore factors such as self-serving biases and demand characteristics (e.g. the customer is unwilling to admit to having experienced poor outcomes if a great deal of time and money has been invested); the possibility that the condition may have run its natural course (i.e. self-limiting or cyclical ailments regressing to the mean); spontaneous remission; the placebo effect (enhanced by touch); the possibility that some allegedly cured or relieved symptoms were probably psychosomatic to begin with; and misdiagnosis.

    Chris wrote: “You are correct in that it is an alternative to the medical approach. And that’s a good thing. Chiropractic is much more than just spinal manipulation and an outdated philosophy – or at least it should be.”

    You seem to be advocating that it becomes physiotherapy.

    Chris wrote: “It’s about ergonomics, diet, core strengthening, balance and lifestyle advice. In fact anything that improves the quality of life of the patient and identifies the CAUSE of the original complaint.”

    But there’s nothing unique about that. Essentially, it’s physiotherapy – a profession that’s already well established.

    Chris wrote: “Its a shame more GPs and medics don’t encompass this approach, instead of incessantly fobbing patients off with painkillers. It would save billions of pounds.”

    How do you know it would save billions of pounds? The evidence tells us that spinal manipulation by chiropractors (which can also be provided by other manual therapists) is effective only for patients suffering from acute low back pain, and even then it is no better than cheaper, safer, and more convenient options.

    • Chris
      January 21, 2013 at 10:44 pm

      “It’s been a 100 years. How long does a profession with such a narrow field need?”

      So what? Medicine has been changing and evolving for thousands of years in all of its “narrow fields”. All healthcare professions need to evolve no matter how long they’ve been established. By your rationale, orthopaedic surgeons should still be hacking legs off using a saw and bottle of whiskey as an anaesthetic as that’s what was seen as being at the forefront of surgery at the time. And if back pain was such a narrow field, why is it still such an apparent enigma to the health profession – surely it would be sorted by now?

      “Why “gradually”? What was it that stopped the GCC from eradicating the large quack element from the profession when the statutory regulation of chiropractors in the UK came into force 12 years ago?”

      Because the GCC are simply a regulator and they cannot sit and watch every chiropractor in the country. They ensure chiropractors are trained and insured and issue guidelines on how to practice, but in the end – as with the GMC – they are mostly reactionary to patient and public complaints. I dont really need to go into details of some of the disasters that have unfolded in the NHS over the years do I? If the GMC were so proficient surely they would have eradicated these problems years ago?

      The current proposals of revalidation are aimed at ensuring the code of conduct and standards of proficiency are adhered to, but its not going to happen overnight.

      “We’ve already been over why the people you see are inclined to think that chiropractic works. I would remind you that you seem to ignore factors such as self-serving biases and demand characteristics (e.g. the customer is unwilling to admit to having experienced poor outcomes if a great deal of time and money has been invested); the possibility that the condition may have run its natural course (i.e. self-limiting or cyclical ailments regressing to the mean); spontaneous remission; the placebo effect (enhanced by touch); the possibility that some allegedly cured or relieved symptoms were probably psychosomatic to begin with; and misdiagnosis.”

      And you seem to forget that this happens in all areas of healthcare not just chiropractic. It’s called physiology and psychology. Are you saying that no chiropractic patients get better because of our treatments and advice? It’s all in people’s heads or simply gets better by itself? Bollocks is the only word that sums that up really.

      “You seem to be advocating that it becomes physiotherapy.”

      “But there’s nothing unique about that. Essentially, it’s physiotherapy – a profession that’s already well established.”

      I’m not advocating that at all and of course its not unique. There will always be some cross-over in advice and techniques in MSK cases. A multi-disciplinary approach is important in patient centered care – if it is required. The major difference is that chiropractors primarily specialise in the diagnosis and treatment of spinal complaints, using manipulation as their main tool. But we also address the causes of those problems.

      Physiotherapy may be established, but (in a lot of my patients experience of the NHS physios particularly) are getting less autonomy/independence when it comes to treating MSK problems. Some of them don’t even diagnose anymore – they are simply told a diagnosis for a referred patient and prescribe generic exercises on a sheet. I even had one patient whose physio had no idea what type of surgery was performed on her shoulder! And the only way she found out was to look at a photo she took of her shoulder prior to surgery – because it was written on it. Awesome communication!

      “How do you know it would save billions of pounds?”

      How do you know it wouldnt? I was referring to the NHS, where repeat prescriptions of standard over the counter painkillers such as paracetamol are rife. I work with someone – a previous GP receptionist – who witnessed thousands of these going out every week. How is pumping livers full of drugs and masking the bodys pain/warning mechanism be more convenient and cost effective than addressing the root causes of the problem in the first place? Especially for chronic and recurrent complaints.

      Anyway – as interesting as these conversations are, I’m going to leave it there. Good luck with your crusade (but not too much obviously ;-)) Without people challenging convention, things don’t improve and move on. Which, believe it or not, many chiropractors want to see in our profession…

      • January 22, 2013 at 12:01 am

        Chris wrote: “All healthcare professions need to evolve no matter how long they’ve been established.”

        But around 90% of chiropractors haven’t evolved. They’re still stuck in 1895.

        Chris wrote: “And if back pain was such a narrow field, why is it still such an apparent enigma to the health profession – surely it would be sorted by now?”

        I wasn’t talking about back pain. I was questioning your limited chiropractic “system” which you said was “growing and evolving”. How can that be true when, after 100+ years, around 90% of chiropractors continue to cling to outdated chiropractic subluxation theory (the only aspect of chiropractic that was ever unique)?

        Chris wrote: “…the GCC are simply a regulator and they cannot sit and watch every chiropractor in the country. They ensure chiropractors are trained and insured and issue guidelines on how to practice…”

        So why don’t those guidelines consign subluxation theory to the bin – or at the very least, not just claim that it is an historical concept, but that it’s also *not linked to health concerns*? See:
        http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1825-subluxations-still-no-evidence.html

        Chris wrote: “Are you saying that no chiropractic patients get better because of our treatments and advice? It’s all in people’s heads or simply gets better by itself? Bollocks is the only word that sums that up really.”

        I think that it is likely that many positive outcomes are due to non-specific effects. Certainly, the more robust evidence that has emerged in recent times is increasingly suggesting that.

        Chris wrote: “…chiropractors primarily specialise in the diagnosis and treatment of spinal complaints, using manipulation as their main tool.”

        “the *treatment* of spinal complaints” Are you sure? There’s definitely not a consensus about that. I’ve lost count of the number of times that chiropractors have declared very vocally that they don’t “treat” anything.

        Chris wrote: “How do you know it would save billions of pounds?” How do you know it wouldnt?”

        You made the claim, so it’s up to you to provide sound evidence that it would.

  58. Sarah
    January 21, 2013 at 10:08 pm

    G.p’s are shit. Have zero knowledge and haven’t got a clue how to examine a patient.

    • Andy Lewis
      January 21, 2013 at 10:25 pm

      Good luck to you Sarah.

  59. Chiropractic rules
    February 28, 2013 at 6:07 pm

    Establishment of The Royal College of Chiropractors

    Further to the granting of a Royal Charter to the College of Chiropractors in November 2012, the Queen has now given permission for the College to change its name to The Royal College of Chiropractors.

    The title Royal was sought to help the public understand that the College has a similar role to the Medical Royal Colleges in terms of promoting standards for practice quality, running postgraduate training for new graduates, providing continuing professional development opportunities and supporting research.

    Tim Jay, President of The Royal College of Chiropractors, said:
    ‘It is particularly important, now that NHS funding for chiropractic treatment is emerging, that patients are aware of their treatment choices, that they know the care chiropractors provide for low back pain is a valid option supported by NICE and that the familiar entity of a Royal College is helping to support their interests.’

    N.B. Within the profession, the College is a voluntary membership organisation which complements the General Chiropractic Council and the professional associations by supporting chiropractors to practice according to patient expectations, to implement good standards of governance, and to base their practice on patient-recorded measures of efficacy and satisfaction. To find out more, visit http://www.colchiro.org.uk

    • March 1, 2013 at 3:39 pm

      Professor Edzard Ernst has caught up with this latest development:
      http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/

      • Dr Quack
        March 1, 2013 at 4:29 pm

        I find it hilarious that people still actually quote Edzard as a reputable “fountain of knowledge” on all matters complimentary related!

        It only takes a basic Masters level understanding of research and how to read a scientific paper to understand that not only are his papers often flawed, full of misuse of research (taking things completely out of context) and ultimately, the biggest mistake in research BIASED (quite transparently), but can you actually not see the HILARIOUS Irony in his EX-position of ‘self-appointed’ chair of Complimentary and alternative medicine, or whatever Throne he created for himself?

        He is the biggest joke of this mission to bring down various therapies in the stupidest way. We don’t even care about what he has to say any more. it’s a case of eye-rolling and saying “oh here he goes again”, but really, we do not worry about whatever Ernst comes up with next.

        Reason being is that philosophically he, like everyone else, is going about it the wrong way.

        Let me offer a more logical solution for you guys, because clearly you can’t think for yourselves, even collectively, so I’m going to point out the obvious to you.

        If you want to stop unethical practice in chiropractic, as in any healthcare profession (I hope you feel equally passionate about it in other professions as much as chiropractic of course, as I do), then you need to have a different approach.

        Anyone can read your material and Ernst’s material and see it for what it is. Biased, NAME-CALLING and ultimately a little childish and unprofessional.

        You are choosing to bad-mouth an ENTIRE branch of healthcare. Generalising hugely, making unsubstantiated claims and trying to portray everyone as the same.

        EVERYONE knows that you can’t generalise about an entire population of people. You wouldn’t say that ALL doctors are incredible, or every policeman is honest, or that all teachers are inspiring, or that the weather is ALWAYS rainy. We ALL know through experience that there are exceptions to the rule.

        So saying all Chiropractors adhere to archaic philosophies, no longer even taught in the UK, and are all sneaky, unethical, dangerous neck-snappers, simply Screams stupidity. And unfortunately being so wrapped up in your mission, you are blinkered to the fact that the general population is more intelligent than that, and most people know someone nowadays with a fantastic story to tell of their chiropractic experience.

        This coupled with a failing NHS and disillusioned patients means one thing. More and More and MORE AND MORE patients will turn to us for the help and relief that we KEEP on providing.

        Our service to the public goes above and WAY beyond what the NHS and “mainstream” medicine provides. We offer symptomatic relief and lifestyle advice which is tailored to the individual. Something the NHS can’t offer sadly, through no fault of their own.

        Let me offer YOU some advice now.

        Be a little cleverer.

        Target specific Chiropractors. Try and do a little more research.

        Find those who GENUINELY practice unethically.

        Become superheroes protecting the public from these swines!!!

        Catch the bad guys and make them suffer for prioritising money over patient health. Oh yes I said it, we are ALL aware it happens. As it does in private “mainstream” medicine too. In fact every day in ALL businesses!

        Catch those naughty chiropractors and make them pay, get them struck off and stop them practicing.

        I want this as much as you do, because THEN it will stop people like ME from getting a bad reputation. No longer then will we good guys have to read and listen to crap like this website and whatever Ernst has to say, though I admire his stamina! WOW not bad for an old man!

        Anyway, just a suggestion.

        I would like to elevate this honorable mission of yours to an above playground level, so that you may actually be effective in your task!

        You’re not exactly getting very far at the moment sadly…….

        Good luck though!

        • Andy Lewis
          March 1, 2013 at 4:47 pm

          No thank you.

          The entire philosophical,ethical and scientific basis of chiropractic is dubious and suspect. And while it is, we will continue to look at the entire profession.

          • March 1, 2013 at 4:51 pm

            Dr Quack wrote: “If you want to stop unethical practice in chiropractic…then you need to have a different approach.”

            Isn’t stopping unethical practice the General Chiropractic Council’s job? It’s been nearly 12 years and we’re still waiting…

          • February 18, 2014 at 6:55 pm

            How about you have a look at General medicine. If you would bother just the tiniest bit to do some research, you’d figure out that half the treatments that GPs offer for which is no ESTABLISHED evidence base, are DETRIMENTAL to the health of the patient.

            Chiropractic on the other hand RARELY harms patients. And you guys are the go-to guys on that right? Tell me, because i know you’ll be commenting, tell me the last accident of chiropractic treatment ?
            (you do know what an accident is right? the difference with an incident? Go look it up, don’t let me catch you out, because it would be really, REALLY dumb of you to let me catch you out on something so utterly basic)

            And then look up the last accident within General Medicine. I seem to recall the needless death of 13,000 patients whilst in hospital care. (Here, in case you draw a blank: http://www.thesun.co.uk/sol/homepage/news/politics/5012503/13000-patients-feared-to-have-needlessly-die-at-14-deathtrap-hospitals.html)

            This discussion is too silly to further engage in. You sir, Andy Lewis, are a half brain. Speak to me after you bothered doing some research.

          • Dr Richard Rawlins
            February 18, 2014 at 7:07 pm

            We know Who writes ‘the Quackometer’ is – Andy Lewis, who is really, Andy Lewis.

            For the record, just who are you?

            And since you ask, an ‘accident’ is a mishap. Do you mean that strokes after chiropractic manipulation are meant to happen?
            Thought not.

            So we are left with practitioners trying, and failing, to ‘adjust’ subluxations which no one save those of that faith have ever identified to exist and to free ‘innate intellengence’ which no one save those of that faith believe in.

            Oh dear.

            Keep the faith, my guess is that you need all you can get.

          • Andy Lewis
            February 18, 2014 at 7:44 pm

            Talking of chiropractors with half a brain, you might enjoy this…

            http://www.quackometer.net/blog/2009/06/joke.html

          • February 18, 2014 at 8:05 pm

            lol841701254 said:

            half the treatments that GPs offer for which is no ESTABLISHED evidence base, are DETRIMENTAL to the health of the patient.

            That’s interesting. Where did you get it from?

        • Carl
          March 2, 2013 at 1:40 pm

          I would argue that chiropractic itself in unethical even when the practitioners are not. They may whole heatedly belive on the efficacy of chiropractic but there is no evidence that it works on much other than lower back pain, so it carries dangers with very little reward.

          Also could you please point out the instances that Edzard has had such poor and from what you have said downright dishonest in his research. I would like to see what you have to back that up

          • Dr Quack quack
            March 2, 2013 at 2:25 pm

            Your knowledge of research is obviously poor Carl. Both with regards to chiropractic research evidence for which there is a plethora and more being published all the time, including RCTs the “Gold Standard” in medical research.

            With regards to Edzard, simply read his papers, if you know much about academic writing you will see he takes quotes out of context, often his references at the end of each paper have a large number of his own papers used, he doesn’t present a balanced argument. Any of these mistakes alone discredits his work, yet alone all in combination! Any scientist with an open mind can see that.

            But his biggest faux pas in my opinion is his grave mistake in website content choice. Anyone who googles his name will be directed to his website. A collection of the ramblings of an old man, quite clearly on a mission to bring down CAM therapies almost completely. When you read some of his less academic writings, his informal blogs, tweets and articles. It takes a few sentences to see that he is a bitter and resentful man who is not open to the research facts under his own nose. Then upon reading his “academic work”, one can see these biases and traits permeating through under a thinly veiled (and poorly referenced) guise. He uses research as a means to fulfil a personal quest, which I personally believe seems to be led by some kind of negative feeling towards our profession. Perhaps he has bad experiences. Who knows?
            But anyone who dedicates their time and energy to a task which is so negative, ultimately futile and done so in such a corrupt and manipulative way, preying on the naïvety of the general public, to me spells deep psychological problems.

            Just my opinion of course…

          • February 18, 2014 at 7:01 pm

            Carlos, He is the editor of his own journals ….. He decides what gets published. As the kids say ROFLMFAO

            It means with every of his publications, the scientific world is Rolling On The Floor, Laughing My F***ing Ass Off

            ;) your guru, your hero. Is a self-proclaimed Ego-tripper. OR should I say, he publishes BOGUS statements? It seems to be a word he is rather hung up on.

            Now Groupie, go and do something meaningfull with your life. And AFTER you have bothered to do some actual research, I’ll be interested in hearing your next genius statement. Perhaps start researching what the word “ethical” means.

            You sir,carl, are also, a half brain. You have, half a brain. People don;t like that.

  60. Johann H Faust
    March 1, 2013 at 4:48 pm

    I think Dr Q must have started the weekend early and not waited until the sun was over the yardarm.

    His ramblings might be taken more seriously if he could actually spell complementary (and if he didn’t stray into ACF territory with the shift lock key).

    I just accidentally typed quackop into Google rather than quackom and the first hit is “quackopractor”. Now, if only I could think of a suitable candidate.

    • Dr Quack quack
      March 1, 2013 at 5:47 pm

      Yet again another comment that refers to petty things such as spelling and grammar, as opposed to the actual content of what I’m writing.

      I apologise your most articulate-ness!

      English is not my first language. Though I hope my efforts are understandable to you. I would hate to think that my points were not clear enough, or required exquisite grammar in order for you to understand the message I’m trying to get across.

      If you would like me to simplify into perfectly spelled bullet points, so as not to distract you with awful use of capital letters and a single miss-spelled word, let me know!

      • February 18, 2014 at 7:05 pm

        Dr Quak Quak,

        With regards to his articulate-ness, Johann H Faust.

        I guess like most critics, they are easily shut up by a well-phrased, down to earth comment. Just wished Edzard would bother to take a hint. If you look up stubborn in the oxford dictionary, you’d get his picture.

  61. Dr Richard Rawlins
    March 1, 2013 at 4:55 pm

    Can anyone point me to a site or reference which offers independent corroboration of the ‘news’ the Queen has granted the CoC the right to use the title ‘Royal’?

    Is it reported in the London Gazette? Or where are such announcements made?

  62. Dr Richard Rawlins
    March 1, 2013 at 4:58 pm

    Mr Quack – why does your site time my last posting as being in the hour of 4 pm when I am on GMT (UTC) and at 3 pm (15:00 hrs)?

    Same applies to you, and others!

    • Dr Quack
      March 1, 2013 at 5:01 pm

      I don’t know Richard. who can tell? Maybe I am communicating from Magical Mystical Chiropractic Land where we operate at our own time zone. Maybe it’s a magic adjustment I performed on your computer? who can tell….. the mystery of chiropractic hey!

      perhaps it’s because I replied on my iPhone, though really I fail to see why it matters to be honest?

      • Dr Richard Rawlins
        March 1, 2013 at 5:07 pm

        I checked the times because it seemed some posters were indeed in a different time zone, and therefore a different country. Which might, and I do say might, account for their often confused postings.

        Only to find I was there as well!

        The time is now 16:07!

        • Badly Shaved Monkey
          March 1, 2013 at 11:29 pm

          In Quackometer-land it’s always British Summer Time.

          Fancy a Pimms?

        • February 18, 2014 at 7:09 pm

          Richard Rawlins, I fail to see any value to your posts. Posts coming form a man who cannot figure out where the government publishes announcements.

          I quote:
          “Can anyone point me to a site or reference which offers independent corroboration of the ‘news’ the Queen has granted the CoC the right to use the title ‘Royal’?”

          Seriously, if you would even bother to research this. It could be as simple as to ask google: UK law royal college of chiropractors. You will find the official documents and hence where they were published, quite immediately.

          I am not surprised why you are struggling with timezones. Perhaps a magical adjustment to your brain would do the world some good.

          • Dr Richard Rawlins
            February 19, 2014 at 9:23 am

            I can do no better than repeat Alan Henness’ explanation that although the CoC has a Charter, it is NOT entitled to use the title ‘Royal’.

            Alan Henness
            January 12, 2013 at 1:09 pm

            I see you’ve made the same basic mistake that many other chiros have made.

            The College of Chiropractors are not entitled to call themselves the Royal anything; they simply now have a Royal Charter of Incorporation – it hands a lot of power over to the Privy Council and simply puts them on a par with the likes of:

            London Homoeopathic Hospital
            The Worshipful Company of Launderers
            The Worshipful Company of International Bankers
            Worshipful Company of Builders’ Merchants
            Society for Promoting Christian Knowledge
            Worshipful Company of Basketmakers
            The Worshipful Company of Marketors
            Basildon Borough
            Girl Guides Association
            The Worshipful Company of Tax Advisers

            No offence to members of these esteemed organisations.

  63. Badly Shaved Monkey
    March 1, 2013 at 11:27 pm

    This coupled with a failing NHS and disillusioned patients means one thing. More and More and MORE AND MORE patients will turn to us for the help and relief that we KEEP on providing.

    Hold on just a cotton pickin’ minute. Exactly for what, beyond sore backs, are you claiming that you and your coterie of soi disant legitimate back-crackers are claiming to offer benefit. Asthma? Eczema? Cancer?

    • Dr Quack
      March 4, 2013 at 10:26 am

      Wow a cotton picking minute! lol are you a hillbilly? Then again with such EXCELLENT command of French you couldn’t be surely! Or maybe you’re a French Hillbilly? Anyway I digress monsieur…

      Whoever claimed to treat anything else?? Not I as you will see if you read my comments. Never once have I suggested that. I have no personal experience with treating anything other than Neuromusculoskeletal problems.

      I should hope that patients who have cancer would be going to their GPs and being referred to an oncology department immediately.

      Honestly will you guys just stick to what we are ACTUALLY saying and not create some hidden meaning which isn’t there please. I don’t talk in riddles and rhymes, partly to make it easy for you all to understand. So I’d appreciate the same in return. Stick to the facts and avoid trying to catch us out. Unfortunately you won’t find anything hidden in what we do. It’s all pretty straight forward and simple. That’s why we welcome this debate quite readily.

      • March 4, 2013 at 2:02 pm

        Quack said, “Whoever claimed to treat anything else??”

        Over 500 chiros whose websites were the subject of complaints to the GCC a few years ago, for a start.

  64. March 2, 2013 at 4:29 pm

    Dr Quack quack wrote: “With regards to Edzard…[diatribe]…He uses research as a means to fulfil a personal quest, which I personally believe seems to be led by some kind of negative feeling towards our profession.”

    Hmmm. What reasons might a career scientist like Professor Ernst have to be biased, and what reasons might you have to lambast him?

    I can’t think of any reasons for the former, but plenty for the latter. Readers can find a fuller explanation in the link below.

    “Who is more likely to be objective, the person whose livelihood is endangered or the independent expert who studied the subject in depth but has no axe to grind?”
    http://edzardernst.com/2013/02/they-would-say-that-wouldnt-they/

    • Dr Quack quack
      March 2, 2013 at 8:17 pm

      Sorry to disappoint you but I won’t even click on a link that leads to that website first of all.

      Secondly your comment is redundant as I don’t feel endangered. In fact I’ve never been busier professionally. I have just secured a number of contracts to look after some major hotels and central london businesses. On top of my clinic work.

      Word of mouth is an EXTREMELY powerful marketing tool it would appear.

      Enjoy your weekend Blue Wode :-)

      • March 2, 2013 at 10:30 pm

        Dr Quack quack wrote: “I’ve never been busier professionally. I have just secured a number of contracts to look after some major hotels and central london businesses. On top of my clinic work. Word of mouth is an EXTREMELY powerful marketing tool it would appear.”

        And marketing is all it is. Indeed, the physicist, Robert L. Park, put it well when he said “anecdotes have a very strong emotional impact, they serve to keep superstitious beliefs alive in an age of science”.

        No doubt, Dr Quack quack, you’d like to see “it worked me” factored into scientific studies…
        http://vicskeptics.files.wordpress.com/2012/02/biw4m-graphic-430w.jpg

        • Dr Richard Rawlins
          March 2, 2013 at 11:44 pm

          What other ‘services’ do these hotels offer? Why would anyone with a medical problem go to a hotel?

          Why won’t Dr Quack tell us his real name?

          Just askin’

          • Dr Quack quack
            March 3, 2013 at 9:32 am

            Are you serious Rich?

            Obviously people aren’t going to the hotel because they have a medical problem, they are guests at the hotel who require treatment for various complaints. The hotel contacts me and I come and treat them. It’s proving far more popular than your standard GP advice and pills! It would seem people do not wish to take drugs to alleviate symptoms arising from joint dysfunction and muscle pain. Something about it not being very effective and just a short term fix, I believe?
            People would rather have the dysfunction corrected, hence my popularity I suppose.

      • March 4, 2013 at 2:18 pm

        Quack said, “Sorry to disappoint you but I won’t even click on a link that leads to that website first of all.”

        It’s the same website where, on Friday 01 March 2013 at 15:05, you left a nasty, ignorant comment – a comment which I challenged you to substantiate.

        http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-13402

        I’m not surprised you don’t want to go back.

  65. March 3, 2013 at 11:25 am

    Dr Quack quack wrote: “It would seem people [guests in hotels] do not wish to take drugs to alleviate symptoms arising from joint dysfunction and muscle pain…hence my popularity I suppose.”

    Or it could be that people who can afford to stay in London hotels like to feel pampered and therefore make extra demands (as opposed to almost everyone else who would simply take a couple of paracetamol and get on with their day).

    • Dr Richard Rawlins
      March 3, 2013 at 11:40 am

      Can we be clear about this:

      A hotel guest has symptoms.
      Who decides what those symptoms are due to?
      The receptionist?

      And they, whoever it is, decide not to call for a doctor, or suggest the nearest A & E, but to send for a chiropractor!

      How do they know they symptoms areise ‘from the musculo-skeletal system’ without taking a history and conducting an examination and assuring themselves that pain from secondary prostatic carcinoma or a cerebo-vascular incident (for example)should not be considered?

      What other ‘various complaints’ have you been summoned to treat?

      Does the hotel receive a kick-back for referring its guests?

      I simply cannot understand on what basis or for what reason a hotel would refer a needy patient to a practitioner of alternative medicine and not a registered medical practitioner.

      And you are seriously misinformed if you think RMPs simply prescribe drugs. They might, but they might not. And a patient can choose whether to take them even if they do.Chiropractors can also prescribe, just not from the restricted list. Aspirin, brufen etc are fine. Do you never take an aspirin your self?

      Your approach to the debate creates a false dichotomy and the staw-man logical fallacy. But I am sure you know that.

      • Dr Quack
        March 4, 2013 at 10:11 am

        Hmmmm Something actually tells me you’re not a doctor at all. You have a somewhat non-medical way of writing that hasn’t aroused suspicion in me until now. But let’s pretend you actually ARE medically trained and I will play along with your answer, ignoring how illogical it seems.

        Here is the more rational answer to your comment regarding the way it works.

        A hotel guest has symptoms, let’s say back pain.

        He calls the concierge, and they perhaps have a conversation such as “Hi I have a pain in my back, do you know anyone who can visit my room to check me out and fix it?”

        The concierge says “Yes, I know a lovely guy who gets amazing results every time he visits our guests here, he is a chiropractor”

        FYI Rich, Chiropractors are more than qualified to take a full case history, rule out red and yellow flags, perform a musculoskeletal examination more thorough than most orthopaedic surgeons (of course owing to time constraints usually for poor NHS medics like yourself [apparently]), and give a pretty accurate diagnosis on the spot. We can then give a full report of findings with regards to the cause, the tissues involved, how to avoid further injury, what to do if further symptoms develop, and give lifestyle modification advice there and then to aid swift recovery.

        The patient says GREAT!!! Now I don’t have to go to hospital and wait for hours only to be told I should take paracetemol and rest for a day but stay mobile (monkeys could give this advice, especially now they are being taught sign language!!).

        “PLEASE give me his number, or could you ask him to come to room…”

        Within 24 hours, I arrive at the room, perform the above typical first visit routine and proceed to immediately treat the patient and provide a level of service unattainable on the NHS, or indeed in mainstream medicine currently”.

        The patient pays me and is immensely satisfied now he can proceed with his visit or business here in the city without wasting time in hospitals or taking pills that won’t help.

        In answer to your comment

        “How do they know they symptoms areise ‘from the musculo-skeletal system’ without taking a history and conducting an examination and assuring themselves that pain from secondary prostatic carcinoma or a cerebo-vascular incident (for example)should not be considered?”

        I will be taking the history and examining the patient for all red flags. These are blindingly obvious to any first year chiropractic student!! Let alone a Doctor of Chiropractic, you’d have to be pretty incompetent to miss them Rich!

        So never you worry my friend, the patient is probably better off and in safer hands with me than in a hospital, and if it’s a hospital they need, I will of course refer them immediately. After all, I can’t fix everything! Just most Neuromusculoskeletal complaints unfortunately!

        But that’s enough to keep me busy!! Especially the way modern society is going in its ever increasingly sedentary manner!

        Have a great week everyone!

        :-)

        • March 4, 2013 at 11:28 am

          Dr Quack wrote: “Within 24 hours, I arrive at the room, perform the above typical first visit routine and proceed to immediately treat the patient and provide a level of service unattainable on the NHS, or indeed in mainstream medicine currently.”

          As a matter of interest, how much do you charge for that?

        • March 4, 2013 at 2:28 pm

          Quack said,

          “Hmmmm Something actually tells me you’re not a doctor at all.”

          I get the same feeling about you.

          Fortunately, we don’t have to make barmy assumptions on the basis of someone’s ‘writing style’ because the GMC have very kindly made their register of medical doctors open to the public.

          I happen to know Richard is a doctor . Your comment about both his and Edzard’s writing style

          • March 4, 2013 at 2:30 pm

            Sorry, meant to say your comment about both his and Edzard’s writing style is frankly bizarre.

    • Dr Quack
      March 4, 2013 at 10:18 am

      Are you saying that most people with back or neck pain should just get on with it Blue Wode?

      I take it you haven’t experienced true back pain then.
      It is not a condition to take lightly and causes a HUGE amount of people a LOT of grief, pain and depression in their lives.

      The people who can get on with it usually do.

      Those who require treatment from us usually cannot function with their pain, that’s why they need something more than just “take a paracetemol and get on with it”.

      Wow, I hope for the public’s sake you don’t work in healthcare!!

      Then again from your ignorant writings, I would assume that you don’t thank god!

      And for the record, there is a SPA in most hotels offering “pampering” services. However as the concierge put it in her own words at a hotel I visited Saturday “we just don’t have any service that can offer pain relief like you do”

      Who needs research papers when people say things like that? FAR more powerful in the public’s eye.

    • Dr Quack
      March 4, 2013 at 10:19 am

      Are you saying that most people with back or neck pain should just get on with it Blue Wode?

      I take it you haven’t experienced true back pain then.
      It is not a condition to take lightly and causes a HUGE amount of people a LOT of grief, pain and depression in their lives.

      The people who can get on with it usually do.

      Those who require treatment from us usually cannot function with their pain, that’s why they need something more than just “take a paracetemol and get on with it”.

      Wow, I hope for the public’s sake you don’t work in healthcare!!

      Then again from your ignorant writings, I would assume that you don’t thank god!

      And for the record, there is a SPA in most hotels offering “pampering” services. However as the concierge put it in her own words at a hotel I visited Saturday “we just don’t have any service that can offer pain relief like you do”

      Who needs research papers when people say things like that? FAR more powerful in the public’s eye.

      • March 4, 2013 at 11:24 am

        Dr Quack wrote: “Are you saying that most people with back or neck pain should just get on with it Blue Wode?”

        Yes, I am. If it’s really bothering them, a thorough evaluation by an MD would be in order, but otherwise they’d be best taking some OTC analgesia and staying active – IOW, toughing it out. Some people, however, have no patience and waste money on unnecessary treatment like chiropractic which has been scientifically proven to be unable to offer anything superior to taking a couple of paracetamol – an option which is more convenient, far cheaper, and probably safer:
        http://www.ebm-first.com/chiropractic/research-and-efficacy.html

        Dr Quack wrote: “And for the record, there is a SPA in most hotels offering “pampering” services. However as the concierge put it in her own words at a hotel I visited Saturday “we just don’t have any service that can offer pain relief like you do” Who needs research papers when people say things like that? FAR more powerful in the public’s eye.”

        I’m not surprised that you buy into a concierge’s anecdotes instead of the scientific data. You have a livelihood (apparently very lucrative) to protect.

        • Dr Quack
          March 4, 2013 at 12:41 pm

          Like your Leader Mr Ernst, you are selecting the research that best suits your argument. Notice that I do not use research to support my arguments because I could do the same thing. I’d rather stick to the tangible facts, the proof in front of me, what I feel and see and hear with my own senses that often cannot be “researched” or subjected to testing.

          I do not “BUY INTO” anything, unlike you Blue Wode who has bought into a narrow way of thinking. I listen to the anecdotes, but they don’t matter much to me, they are what they are, people like to talk, people like me, people get better. It’s great and it helps the profession to grow, as it always has and always will. There is no buying into things.

          You “buy into” a WAY of thinking.
          I have my own, I can think for myself quite easily… so I don’t need to buy into anything.

          I charge £80 for the visit. You will find that commonly chiropractors will charge around £40 for a treatment, which lasts anywhere between 10-30 minutes.

          I charge double that for twice the length of treatment time, and also the fact that I save the patient hours of travelling. They are MORE than happy in paying this. They also have the option to visit my home for treatment and pay just £30 for my convenience, or they can come to the clinic where I work and pay £44 for a treatment.

          We are also in the process of applying for and getting an NHS contract. MANY of my colleagues in the Chiropractic world have already secured NHS contracts to provide FREE chiropractic on the NHS.

          Were you aware of this? The new NHS AQP scheme??

          So basically if you wish to chase a pathetic argument about costs, and how “lucrative” the profession is. Be my Guest. But the argument will be very short lived when you consider how much an orthopaedic surgeon will charge for a private consultation with NO treatment. And then how much they rape their patients for ACTUAL treatment.

          I think in hindsight then £30-80 for immediate pain relief on the spot with no anaesthetic and no cutting open of patients and little or NO side effects is WELL worth the Money.

          you are fighting a losing battle Mr Wode.

          And may I ask what exactly it is you do yourself Mr Humble Samaritan. Let me guess? A crime fighting superhero? A Buddhist monk? A volunteer for numerous charities?

          • March 4, 2013 at 1:21 pm

            Dr Quack wrote: “Like your Leader Mr Ernst, you are selecting the research that best suits your argument.”

            Do you have anything better than Cochrane systematic reviews which head up the page I linked to?

            Dr Quack wrote: “Notice that I do not use research to support my arguments because I could do the same thing. I’d rather stick to the tangible facts, the proof in front of me, what I feel and see and hear with my own senses that often cannot be “researched” or subjected to testing. I do not “BUY INTO” anything, unlike you Blue Wode who has bought into a narrow way of thinking. I listen to the anecdotes, but they don’t matter much to me, they are what they are, people like to talk, people like me, people get better. It’s great and it helps the profession to grow, as it always has and always will.”

            IOW, you follow a quack’s charter.

            Dr Quack wrote: “I charge £80 for the visit. You will find that commonly chiropractors will charge around £40 for a treatment, which lasts anywhere between 10-30 minutes. I charge double that for twice the length of treatment time, and also the fact that I save the patient hours of travelling. They are MORE than happy in paying this. They also have the option to visit my home for treatment and pay just £30 for my convenience, or they can come to the clinic where I work and pay £44 for a treatment.”

            That’s a nice earner. No wonder you don’t like to use research.

            Dr Quack wrote: “We are also in the process of applying for and getting an NHS contract. MANY of my colleagues in the Chiropractic world have already secured NHS contracts to provide FREE chiropractic on the NHS. Were you aware of this? The new NHS AQP scheme??”

            Yes, I am, and it’s scandalous that the chiropractic ‘bait and switch’ is being overlooked because it means that patients will be put at risk of being ensnared by quackery and receiving an intervention that could have lethal consequences:
            http://www.dcscience.net/?p=1516

            BTW, it’s ‘Professor’ Ernst, MD, PhD.

  66. Dr Richard Rawlins
    March 4, 2013 at 12:36 pm

    Please cut out the name calling – Andy Lewis knows perfectly well who I am and so could you if you were bothered.

    On the otherhand in spite of regular requests you persistently refuse to tell us who you are. Very un-professional, and the hallmark of a quack,

    You have still not answered what these ‘various complaints’are that you are summoned to hotels to treat.

    And please read my inquiry. I do not doubt you conduct a history taking and examination, but how does the hotel receptionist know that the guest’s complaint of say ‘back ache’ is ameniable to treatment by a chiropractor?

    If I was managing such a hotel I would expect a receptionist to call a registered medical practitioner.

    And you have not answered as to whether the hotel or receptionist gets a fee for making the referral. Do they?

    And please explain why you not tell us your name so that we can judge your professional status. Otherwise we will have to take you at your word and assume you are what you say – a Quack.

    Says it all. Let’s move on shall we?

    Any corroboration that the CoC can now style itself as ‘Royal’? That is the subject of this thread.

    • February 19, 2014 at 2:11 am

      Also remember that research is unscientific but hotel receptionist quotes are the real proof that something works.

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