McTimoney Chiropractors told to take down their web sites

This letter has been issued from the McTimoney Association to all its members…

Date: 8 June 2009 09:12:18 BDT

Subject: FURTHER URGENT ACTION REQUIRED!

Dear Member

If you are reading this, we assume you have also read the urgent email we sent you last Friday. If you did not read it, READ IT VERY CAREFULLY NOW and – this is most important – ACT ON IT. This is not scaremongering. We judge this to be a real threat to you and your practice.

Because of what we consider to be a witch hunt against chiropractors, we are now issuing the following advice:

The target of the campaigners is now any claims for treatment that cannot be substantiated with chiropractic research. The safest thing for everyone to do is as follows.

  1. If you have a website, take it down NOW.

When you have done that, please let us know preferably by email or by phone. This will save our valuable time chasing you to see whether it has been done.

  1. REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them. DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.
  1. If you have not done so already, enter your name followed by the word ‘chiropractor’ into a search engine such as Google (e.g. Joe Bloggs chiropractor) and you will be able to ascertain what information about you is in the public domain e.g. where you might be listed using the Doctor title or where you might be linked with a website which might implicate you. We have found that even if you do not have a website yourself you may still have been linked inadvertently to a website listing you or your services.

CHECK ALL ENTRIES CAREFULLY AND IF IN DOUBT, CONTACT THE RELEVANT PROVIDER TO REMOVE YOUR INFORMATION.

CHECK OUR PREVIOUS EMAILS FOR SPECIFIC ADVICE AND KEY WORDS TO AVOID.

KEEP A LOG OF YOUR ACTIONS.

  1. If you use business cards or other stationery using the ‘doctor’ title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.

5. Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice.

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.

IF YOU DO NOT FOLLOW THIS ADVICE, THE MCA MAY NOT BE ABLE TO ASSIST YOU WITH ANY PROCEEDINGS.

Although this advice may seem extreme or alarmist, its purpose is to protect you. The campaigners have a target of making a complaint against every chiropractor in the UK who they perceive to be in breach of the GCC’s CoP, the Advertising Standards Code and/or Trading Standards. We have discovered that complaints against more than 500 individual chiropractors have been sent to the GCC in the last 24 hours.

Whatever you do, do not ignore this email and make yourself one of the victims. Some of our members have not followed our earlier advice and now have complaints made against them. We do not want that to happen to you.

Even if you do not have a website, you are still at risk. Our latest information suggests that this group are now going through Yellow Pages entries. Be in no doubt, their intention is to scrutinise every single chiropractor in the UK.

The MCA Executive has worked tirelessly over the last week keeping abreast of development and contacting at risk members. We have decided that this is our best course of action to protect you and the Association at this time of heightened tension. This advice is given to you solely to protect you from what we believe is a concerted campaign, and does not imply any wrongdoing on your part or the part of the Association. We believe that our best course of action is simply to withdraw from the battleground until this latest wave of targeting is over.

Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond.

Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.

Please be aware that the office phone lines are likely to be busy, so, if you need our help, please send an email to the office and we will get back to you as soon as we can.

Yours,

Berni Martin

MCA Chair.

Best wishes,

Nicki

Stunning. What have they got to hide?

The McTimoney web site itself now just reads:

For all enquiries regarding McTimoney chiropractic, please contact :

McTimoney Chiropractic Association
Crowmarsh Gifford
Wallingford OX10 8DJ
[email protected]
Tel : 01491 829494

The most stunning admission is that Chiropractors are told:

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.

****************************************************************************************************

Update:

All the missing websites have been archived here: http://yaxu.org/tmp/chiros.html

Smashing job yaxu

PS Dont forget to sign the Simon Singh support campaign.

http://www.senseaboutscience.org.uk/index.php/site/project/333/

249 Comments on McTimoney Chiropractors told to take down their web sites

  1. Good grief.

    It's not quite a smoking gun, but the phrase "any claims for treatment that cannot be substantiated with chiropractic research" followed by "whiplash, colic or other childhood problems" rather suggests that they're *aware* that there is no evidence for efficacy for the use of chiro to treat those conditions.

    It puts Eady's ruling in an interesting light.

    • THE ANSWER IS LOGICAL AND EASY

      Be like Switzerland, Germany and France, Give your patients the freedom to choose which branch of medicine they would like to use. In Canada Homeopathic dispensing is available on the high street in the chemists.

      Allopathic, Homeopath, Acupuncture, herbs, Osteopathy, Chiropractic are all registered & regulated within the state health system.

      • THE ANSWER IS LOGICAL AND EASY

        Require all medical therapies to demonstrate efficacy and safety before funding them with public money.

        Require any therapy shown to be dangerous or inefficacious to be withdrawn from public use or private sale.

        There we go. The problem of “alternative” medicine solved in two sentences.

      • Overlooking the fact that you call of these pseuderies “branches of medicine”, there are at least two sorry consequences for this.

        The most serious is that this allows parents to choose inadequate treatment for their children with serious-to-tragic consequences.

        The other, as I’ve found from living in France, is that chemists follow the profit motive and suggest homeopathic remedies to customers.

    • Just a thought but……

      Have any of you thought about the reason why there has not been any research in these fields? Funding for scientific trials has to come from somewhere……
      Also with EVERY type of medicine, western medicine, alternative medicines, they are not 100% going to have the desired effect on everyone, i mean jesus if you really want to put your energy towards slapping anything down it should be towards the drug companies who skrew us over everyday, or the 100s of potions and pills saying they are going to make you lose weight or look younger. Anyone ever looked into the ‘scientific testing’ of these products? At the end of the day, chiropractors only want to help people, now as long as they arent hurting anyone is there really a problem, if it doesnt work for you, don’t go back, simple! I’ve personally spent more money than what it would cost for one chiro treatment on makeup and lotions that claim to do things that they haven’t! Thats just the way life is, everyone is differn’t. And to all of those that claim people have been hurt by chiro, a) In every profession there are mavericks (Look at the doctor who ‘looked after’ micheal jackson) they make everyone else look bad and people just love to concentrate on horror stories rather than succes stories and b) How many people have had terrible adverse reactions to modern medicine? Alot of people have died (not that anyone talks about it because the relevent parties sweep it under the carpet before anyone finds out).
      I think also a thought should be given to the people that are being pursecuted, about their families who rely on them to pay the bills and put food on the table. Is it really fair, and why do the people that are complaining care so much anyway? Do something useful like campain to have more money put towards cancer research instead, there are much more important things in this world to put your energy towards. People deserve to be able to choose what treatment they undergo.

  2. That's really astonishing.

    I wonder how professional bodies in proper medicine would respond to a campaign against their specialty? If practitioners were making unevidenced claims on websites and in advertising, actually in contravention of trading standards, would their professional body "have their back" like this? Actually try and prevent offenders being discovered?

  3. I haven't even received an acknowledgement of my complaints yet!

    It's a pity it's taken till now to finally make them take down anything that can't be backed up by research and to stop them misleadingly using the title 'Dr'.

    If chiropractors hadn't been making claims that were not backed up by research, if the GCC had been doing their job properly in keeping their members in line, this wouldn't have been necessary. This is not a witch hunt: just making sure 'bogus' claims are not being made.

  4. In light of the furore over "happily promoting bogus treatments", might this serve as some evidence even of the "Eady meaning"?

  5. And they are doing it.

    My local backcrackquackery has already changed their website big time.

    Last week they claimed that:

    """"""Chiropractic care has been beneficial in a wide range of child-hood ailments, including:

    – ADHD
    – Asthma
    – Bedwetting
    – Colic
    – Poor posture
    – Allergies """""

    All of these references have gone now.

    Plus they have modified the use of the word Doctor. One is referred to as a Doctor of Backcrakery and the other uses the title doctor (backed up with a Ph.D from the University of Wales which is probably justifiable although I would argue that it probably depends on what it was).

    They have remodelled themselves as a sort of aches and pains outfit with all sorts of high tech gizmos to detect your subluxations (yes that nonsense is still there).

    It still seems to be a load of nonsense though with claims that:

    """"A computerised nerve and muscle scan is performed to determine the state of the nervous system"""

    """SECOND GENERATION SUBLUXATION STATION. Our state-of-the-art technology will objectively help us: DETECT AREAS OF NERVE DISTURBANCE"""

    """The three standard tests will measure:
    – SEMG – the amount of electrical current in the muscles.
    – Thermography – skin temperature along the spine.
    – Inclinometry – range of movement of the spine."""

    And there is a nice diagram of a spine with it's SEMG patterns. Any bets on most of these being red when you pays your money and takes your choice of quackery.

    ALthough they make it up, just to prove that I don't here is the science:

    http://www.victoriachiropractic.co.uk/do.asp

  6. "…the other uses the title doctor (backed up with a Ph.D from the University of Wales which is probably justifiable although I would argue that it probably depends on what it was)."

    Not quite sure about that: the GCC code of practice says that "chiropractors who use the title of 'doctor' and who are not registered medical practitioners must ensure that they make it clear that they are registered chiropractors and not registered medical parctitioners" (my emphasis). I'm not convinced that merely waving a PhD around achieves this.

  7. Wow. That's quite a turnup.

    The explicit equating of "we're being prevented from making claims we can't back up" with a "witch hunt" is quite extraordinary.

    Rocko.

  8. "Would this be admissible as evidence in the Simon Singh case?"

    Unfortunately this was sent out by the MCA, so it isn't evidence of what the BCA believed.

  9. *WIN*
    It's slightly disconcerting to think that they assume sceptics are on a "witch hunt" rather than just trying to establish that when someone says they can cure all manner of ailments, they are able to show us the proof. Is there really a lack of funds to test these claims?

    Last time I checked, it was bloody expensive to visit a chiropractor. As my dear old mum used to say: "Where there's a will, there's a fortune to be made"…

  10. Witch hunt? It's like shoplifters caught on camera claiming the shopkeeper has a grudge against them. That's alternative realitiy medicine for you.

  11. Witch hunt? It's like a shoplifter being caught on camera then claiming the shopkeeper has a grudge against them.
    This just so reeks of deliberate dishonesty.

  12. "Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice."

    The SoH issued a similar warning to its members in 2007. See DC's blog:

    http://www.dcscience.net/?p=208

  13. AHAHAHAHA

    "Hey guys, you know how we're selling quackery and calling ourselves doctors? Well, tone that down for a bit. Be suspicious if anyone asks you how our treatments actually work, and for goodness sake DON'T ANSWER THEIR QUESTIONS!"

    Never once a suggestion that evidence be produced. I've always kind of wondered if they actually believed it, or were just lying, but this is a smoking gun showing that they know what they're up to.

  14. "Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond."

    What? Keep buggering on regardless of the patient? It's an interesting perspective on the purported patient-centred, holistic care model that areas of chiropractic remain so controversial that these shouldn't be discussed.

    How is is ethical to stifle the debate about the quality of chiropractice evidence? My experience of patients is that they don't usually feel burdened when they are given decent quality information.

  15. "Keep buggering on regardless of the patient?"

    I think that is probably a different kind of offence. 🙂

    More seriously, I have found this "It's an interesting perspective on the purported patient-centred, holistic care model that areas of chiropractic remain so controversial that these shouldn't be discussed." to be a widespread phenomenon in the world of woo. Pleasant superficial manner but deeply intolerant of challenge.

    I think it reflects a deep mindset with these people that they are utterly devoted to the idea of "Authority" though what they market is often wrapped up in a blanket of left-field 'alternative' free-thinking. They might be an alternative to the mainstream, but they are not free-thinking at all.

    Because their arts have no rational evidential base the only source of their confidence is the faith they place in the authority of their teachers and, once trained, they demand that respect is paid to them because of the authority they have now acquired. Scratch below that surface and all sorts of nastiness jumps out.

    I declare Godwin's law to be fulfilled at this point and state that their view point is actually fascist. As Wikipedia says "Fascist governments forbid and suppress criticism and opposition to the government and the fascist movement." Insert chiropractic, homeopathic in place of fascist and see how the sentence sounds.

  16. "I declare Godwin's law to be fulfilled at this point"

    I think it was already fulfilled when Richard Brown complained that "pro-Singh professional and lay scientists have mounted a nationwide campaign of intimidation against chiropractors and via widespread blogging have encouraged a ‘blitzkrieg’ against the BCA."

  17. Well done all who have lodged complaints and caused them to run from the 'field of battle' even thought they are portraying it as merely a strategic withdrawal it certainly looks like a rout. Anyone keen to be a cossack and harry them across the Elbe? Shall we use the MCA as the massacre in Smolensk with the BCA and their lawsuit Murat and the valiant rearguard?

    Sorry, always been fascinated with Napoleon's greatest failure (sorry Britophiles, it wasn't that skirmish at Waterloo).

    @Jason it certainly could be seen as prima facie evidence that the MCA are not confident they have a valid defence against the complaints. If they don't I doubt the BCA do, go for it Simon Singh!

  18. Google cache doesn't appear to suffer from the robots.txt problem. Just do a search, use the "more results from…" option if it's there than view the cached versions of individual pages.

    Note that Google cache often changes quickly.

  19. As I see it, this "smoking gun" will be of little use to Singh unless he loses all appeals and finds himself having to defend Eady's definition of his intent (after all, he's not claiming the BCA knew of the lack of evidence).

    And even then, the plaintiff could probably claim they weren't aware of the lack of evidence before the ASA ruled on it.

  20. John H@10 June, 2009 10:34:

    That page you linked to (http://www.victoriachiropractic.co.uk/do.asp) is hilarious:

    "The three standard tests will measure:

    * SEMG – the amount of electrical current in the muscles.
    * Thermography – skin temperature along the spine.
    * Inclinometry – range of movement of the spine.

    green bars: mild
    blue bars: moderate
    red bars: severe "

    Mild, moderate or severe what?

    My back is warmer in some spots than others, and the electrical monitor is picking up… electric flux that my heart produces during every beat? higher galvanic skin response? higher conductivity produced by sweating?

    And what does this indicate? That I just walked up the stairs to the clinic? Colic? Bad chi flow? Demon possession? Lupus?

    I'd loooooooove to see an electrical schematic for their e-Meter^H^H^H^H magic box^H^H^H^H "Second Generation Subluxation Station".

    More on these silly boxes:

    http://www.quackwatch.com/01QuackeryRelatedTopics/electro.html

  21. Note: I can still see the Bassett Chiropractic Clinics website that is listed on yaxu's site. Does this mean that some chiropractors on the list have not yet taken their websites down?

  22. I wonder how popular the BCA are with the other chiropractic organisations and GCC?

    It also puts the BCA in an awkward position, do they send a similar email to their members to protect them from 'persecution' and thus admit that they know their members offer 'bogus' therapies or do they do nothing and let their membership suffer?

  23. i apprieciate the importance of evidence based research and practice but you lot on here seem rather blind to the fact that a HUGE proportion of mainstream allopathic medical treatments are not backed up by "gold standard" RCT evidence. I accept that people shouldnt make claims stating things as "fact" when there isnt any evidence for it. But as far as i'm aware, using the best available evidence is scientifically sound, so if most people seem to benefit from heart surgery for heart disease, then lets do it, doesnt mean there have been any RCT placebo trials on it though.

  24. As Gimpy has said here;

    "I wonder how popular the BCA are with the other chiropractic organisations and GCC?

    It also puts the BCA in an awkward position, do they send a similar email to their members to protect them from 'persecution' and thus admit that they know their members offer 'bogus' therapies or do they do nothing and let their membership suffer?"

    and I have said at zeno's site

    "What do the websites of BCA members currently say?

    If they suffer a rash of mysterious disappearances then some ineluctable conclusions may need to be drawn that would begin to impinge on BCA vs Singh quite significantly.

    Have you checkmated them?

    Website makes dubious claims;

    1. Leave website alone. GCC should fulfill its statutory obligations and pursue them via their disciplinary process.
    2. Take website down. Prima facie evidence that claims are 'bogus' in the sense imputed by Mr Justice Eady."

    They are now royally screwed.

  25. Wonderful news – but why has it taken so long? Why have quacks been allowed for so long to make bogus claims and fleece the desperate and the gullible of the back of it?

    Let's hope this is the start of the end….

  26. Oh, dear, we have someone who doesn't seem to understand what we mean by evidence.

    Obviously not all of medicine has double-blind trials, but it uses methods that have biological plausibility, so the likelihood of observational studies genuinely spotting true causative effects from treatment are concomitantly higher, while accepting that the double-blind study is still the best.

    Your therapy has zero biological plausibility, so the quality of any trial evidence you would require to overcome that obstacle has to be nearly infinite. Observational studies and anecdote are utterly worthless to you or to your deluded victims.

    So, BackQuacker, Answer one, just one, question. Please provide unequivocal evidence of the existence of the "subluxations" on which chiropractic is based. These represent your core assertion. If you cannot demonstrate their validity you are no more than an ill-trained physiotherapist who will occasionally kill someone with an arterial dissection.

    Meet my friend, the Reverend Bayes. He is your worst nightmare.

  27. They should be warned that removing the information from websites is ok, but if they were in the US, destroying it to avoid possible prosecution is illegal and is obstruction of justice.

  28. BSM: Dont be fooled by my name, im not a chiropractor, im an osteopath 🙂
    I can't begin to start defending chiropractic therapuetic rationalisation since i wasnt trained as one. What i do know is that there's quite a bit of evidence showing that spinal manipulation is more effective and statistically much safer for low back pain than NSAID use. Given that most chiros and osteos spend day in day out treating back pain in this way, its of far more relevance than whether or not a few chiros think they can cure colic in babies.
    The NICE guidelines published this month now point to spinal manipulation being "best practice" for acute and sub acute Low Back Pain, so obviously there is a little more to manipulative therapies than you arrogantly seem to think. Have you actually researched any of this evidence yourself i wonder or are you just jumping onto this intellectual band wagon?

    • what about exercise?? as far as I knew that was the only back pain treatment wtih good solid exercise behind??
      what’s more it’s almost free (takes very few, good educational sessions to sort with a patient) and requires no if any follow-up… oh, but that’s right… where would your income come from???

    • I am a patient of chiropractice

      I have use it for arthritis and like all professions there are good and bad practitioners

      When i used a bad practitioner he made it worse. I found a woman McTimony practitioner who relieved my extreme back pain after the first session. I went from walking with a stick to walking unaided after three sessions.

      She never claimed to ‘Cure all’ in her surgery and i do not think they should

  29. I think the more interesting question is have the Chiropractors researched their claims themselves or have they just jumped on a pseudoscientific, cult-like bandwagon?

  30. I think that you are mistaken that these guys will see this as an admission that their treatments don't work. The placebo effect and confirmation bias will have convinced most of them that what they are doing works and it is "evidence based medicine" that is the sham.

  31. Michael J – we do not expect for a moment that any chiropractors will have the insight to realise what is going on.

    Today they will have been milling around like puzzled homeopaths. Uncomprehending. Angry. And probably ready to lash out.

  32. Well, the trouble with sites like this is that you are all so partisan. So many of these comments done seem to be by people who are interested in doing some actual reseach themselves into these matters. Like i already have said, im not a chiropractor im an osteopath who's just finsihing an evidence based research MSc in Pain Management. Ive spent the last two years researching evidence for back pain treatments and osteo and chiro stand up fairly well. In the tools used to judge hierarchy of evidence such as PEDro and Jadad, there is an inbuilt favouritism towards pharmacuetical testing since its impossible to double blind manipulation. This to some extent puts these therapies at a disadvantage, even so, there's still a fair bit of decent evidence out there if you can be bothered to look. This site seems to be more of a pissing contest than an grown up discussion about what evidence might ectually exist.

  33. "This site seems to be more of a pissing contest than an grown up discussion about what evidence might actually exist." That is because BCA is trying to stop discussion and scientific challenge…

  34. On a web tour of Leeds chiropractors: websites and 'doctors' still in place… And claims like:

    'As your baby becomes a toddler they will experience all the normal bumps and bangs associated with crawling and learning to walk. This can cause their spine to become misaligned and cause more problems such as glue ear, recurring coughs and colds, hyperactivity and bed-wetting. It is far easier and quicker to deal with spinal problems at this stage rather than ignore and allow them to become chronic in later life.'
    http://www.roundhaychiropracticclinic.com/common_conditions_we_treat.php

    Is there evidence that childhood bumps misalign the the spine and lead to hyperactivity, chronic spine problems etc? I think the burden of evidence is against this, and so I do not see that you can prove a treatment efficacious for conditions that any way do not follow.

  35. … and (re the Leeds chiroprator claim) I am concerned about therapists who on the one hand write material that can scare parents into seeking treatment, yet not divulge to them the serious level of doubt that surround the treatment on offer due to lack of evidence.

  36. Well i take your point and im totally against the way the BCA have behaved. Makes them seem paranoid, delusional, defensive and childish, but the original point of this whole debate was surely to assertain whether there's any evidence for what chiropractic claims to do. I think we can safely say that about 99% of the people on this site all agree with Singh and agree with each other, so you're all preaching to the converted really. Its all a bit masturbatary.
    More interesting would be to actually look into the evidence and discuss it, but im guessing , and i might well be wrong, that no one here has bothered doing that. Its far easier to sit back on here and feel smug.

  37. ANONYMOUS: I absolutely agree with what you're saying. Thats shockingly unethical in my view and i would never make such claims about my own osteopathic treatment. There sadly, many osteopaths and chiropractics who do make all kinds of highly presumptive claims about their treatments and give us all a bad name.

  38. Back Quacker: I think its brave of you to come and make your points here 🙂

    It sounds as if you seek to run an ethical practice, but that your decisions as to the claims you make for osteopathy are those you make as an individual practitioner. Do you think it would be possible to introduce an ethical code governing the claims that could be made by all osteopaths / chiropractors? Wouldn't this have to use evidence as its touchstone? This would then protect you from unscrupulous practitioners bringing down the reputation of the therapy you offer. If the therapy really works, there is a powerful economic as well as ethical driver for securing the research that would give you reputable evidence and a basis for a shared and transparent code of conduct.

  39. Back Quacker: the issue here is not lower back pain. As you say, there is evidence to support that. What is specifically in question are the claims to be able to treat conditions where there is absolutely no medically feasible mechanism available, and where turning to a chiro first instead of your GP can be directly harmful.

    There is a deeper question here that I don't often see addressed. The question is not "What are you doing?" but rather "What are you doing to improve what you are doing?" Allopathic (and evidence-based in general) medicine can point to a rational, scientific process as an answer to this. Chiropractic practice, as embodied by those practitioners who have had to change their websites, cannot and does not.

  40. Interesting points and as an individual osteopath ( but far from being the only one out there) who treats patients with musculoskeletal pain and disability in a very straighforward manner, using evidence to back up what i do whenever possible, i find these claims made by chiropractors very familiar. These are similar claims made by a huge ammount of osteopaths and this is something which the world of osteopathy is very devided over. I spent last saturday at a General Osteopathic Council conference where the bulk of the time was spent discussing this very point. The GOsC are at present trying to draw up some kind of more unified, and evidence based Osteopathic Framework. Isuppose one could say its rather timely and all this chiro crap could actually work in our favour if we put our own house in order.

    I will say one thing though, it would be a mistake to cling to closely to the idea that allopathic medicine is based on "good science" and scrupulous testing. Have any of you seen the death rate of NSAID users? Shocking!

  41. If anyone is at all interested in the evidence base for manual therapy then an excellent place to start is a book by Prof Eyal Lederman: The Science and Practice of Manual Therapy. An excellently researched, evidence based and clearly written attempt at identifying the biophysiology behind manual therapy.

    There you go you grumpy ol' skeptics!!

  42. "Because of what we consider to be a witch hunt against chiropractors…"

    If it looks like a duck, walks like a duck, quacks like a duck, and weighs the same as a duck…

  43. Back Quacker: I'd really hope that most of the people here would call for evidence-based medicine with regard to drugs etc. as well. It's not an either-or situation. As you say, it shouldn't be a partisan issue. Manipulation-based therapies for various musculoskeletal issues don't seem to be problematic.

    Glad that you're here and hope you don't feel personally got-at. Thanks for references – I'll have to look through them when I'm in the university library.

    In an unrelated therapy, am starting physio tomorrow…

  44. "Allopathic" and its cognates are like "scientism" and its cognates. I.e. indicators of some seriously woolly thinking and a likely precursor of bullshit. One might even consider them symptoms….

    Why is it that "alt med" types think this is some species of team sport? The cries of "tu quoque" every time anyone asks for evidence supporting their claims is deafening. There is no such thing as "alternative medicine", it doesn't exist. There is stuff that works (medicine) and stuff that doesn't (wishful thinking). If wearing a toad on your head at midnight whilst chanting an Inuit death song and chewing a piece of yew tree whilst sitting at a crossroads cures your cancer (and can be demonstrated to do so in a decent trial and each element has a demonstrable mechanistic input) then it's "medicine", there's nothing alternative about it.

    Consilience is one of the many things that "alt med" proponents (and all other species of denialists from Holocaust denier to creationist) can never understand.

  45. Wow 70 posts in 17 hours! Is this a penny share that has just doubled? No it's just a bunch of geeks having a party on the internet. The sore heads in the morning will be a pretty sight!

  46. Hi Simple Simon, I honestly know nothing about chiropractors. Just curious about the excitement and the currently steamy lenses of your thick goggles. So weird what you get off…

  47. @Stewart: Yipes. Silly intertubes; that comment came across as a hell of a lot more dark than I had intended. I was referring to the homeopathy books at the bookstore linked under your username, but I think it probably best if I just tuck tail after that one.

  48. Simon, if I had a magic flower on my leather jacket and five wishes I would include a wish for some scientific thinking in the homeopathic world. I'm the wrong guy to attack believe me. If it's all baloney I could find something else to do. I do my best talking to whoever I can about double-blind re-provings of the most commonly used remedies. Perhaps one day my dreams will come true.

  49. Even if this letter had been issued by the BCA rather than the MCA, I don't think it could be taken as any sign of guilt. They most likely are convinced by their clinical experience that the treatments they offer are effective, and see the demands for non-clinical evidence as a form of persecution. I'm not trying to claim that they're right, merely that they're being honest.

  50. It seems that they are copying the tactics of the Roman Catholic Church when caught out, vis: cover it up in an institutionalised manner, and protect the guilty, meantime blaming the whistleblowers as being the root cause of their troubles!

  51. Back Quack, you seem not to have either read or understood my first reply to you. It was also not helpful to style yourself "Back Quack" in a discussion of chiro then say you are not a chiro. Chiros are quacks.

    The tu quoque fallacy is always a fallacy, but actually, and strictly speaking, it requires that there is a direct parallel between the two parties being compared. The idea, though, is that a fault of the second party does not refute the same fault in the first party.

    BUT, the faults are not the same! Do you get it? Proper medicine may use therapies that do not have the full weight of DBRCTs behind them, but they have biological plausibility. This makes the inherent likelihood of inferred claims of causality being true effectively infinitely greater than the claims of a quack therapy with zero plausibility.

    So, you have attempted to deploy a logical fallacy in your argument, but can't even get that right.

    When you have read up on Bayes theorem and understood the ideas you will have earned the right to an opinion. Until then all I can hear is quacking.

  52. p.s. The fact that chiros may, accidentally, help to improve back pain no less badly than a host of other rather useless treatments even though their techniques are based on a flawed theory does not validate that theory and does not validate claims that their therapy has any positive impact on any other medical condition. You need to lift your sights from the narrow field of back pain. Chiro claims to be a universal form of medicine, just like homeopathy and a variety of other childrens' tales. Officially it doesn't even believe in the germ theory of infectious disease!

    The time has come for the chiros to decide what they want to be. Chiropractic is a brand with a lie at its heart. Honest chiropractors need a new brand or they need to admit that lie and redefine the brand as something more akin to physiotherapy. How they would then be regulated and who would do it are then questions that need to be answered. First, they have to show the courage and integrity necessary to make that change.

  53. BSM: Yes i "get it" and what a charmer you are.
    @bsm
    I chose my name on here to take the piss a little, both out of myself and out of self righteous skeptics on here. As far as chiro goes there's a lot of biophysiological evidence for what they do in terms of musculoskeletal pain, as there is in osteopathy and also physiothereapy. Beyond that, i doubt there's much at all. Im not here to defend chiropractic, nor to get into a debate with someone who evidently hasnt bothered to do any research themselves. Or have you?

  54. As a matter of interest, does anyone know what was in the previous email referred to in this one?

    "…we assume you have also read the urgent email we sent you last Friday."

  55. Regardless of anyone's point of view or beliefs, why isn't this all over the news? An organisation is telling its members to effectively hide their activities when they had been previously public. I'm surprised the chiropractors aren't asking questions publicly. If an organisation I had trusted and believed in did this I'd want to know what was wrong. Maybe they are.

  56. Evidence-based? Chiros dont have a lot of but results they do… Drug companies typically fund research and given that chiros (and other health practitioners alike) have been focussing on results rather than doesn't make them any less effective in restoring health. It's unfortunate that the profession didn't see this coming earlier since the scientific community has narrowed it's acceptance of substantial 'evidence'. The evidence is in the patients who do improve- chiros (and others) just need to find a means of getting that info out there. Hopefully this can find a peace ground considering both the chiros and the bio-meds both want to see people healthy – No doubt they both have offering here.

  57. Anonymous – "spoken like a true quack – we just need to tell the world how great we are." You are indistinguishable from homeopaths who just think that they need to evangelise more to those who have not heard the message.

    The standards of evidence that are asked of for chiropractic are not arbitrary. They exist because there are well known ways in which we can fool ourselves into believing a treatment is effective when it is not. Simply asking patients if they have got better does not tell you if cracking their back was responsible, lessened symptoms or was worthwhile. Back pain fluctuates and gets better on its own. You have to show you can do better than nature.

  58. "Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else."

    D'oh!

  59. Le Canard Noir, I understand you have your stance and seem to be fairly inflexible about it. I'm honestly not here to make an attack. Only put across a view which has seems to have fallen on deaf ears here. I guess only time will tell.

  60. I am quite prepared to change my mind (and be flexible) when the BCA decide to make public what they believe to be the evidence that chiropractic can treat colic, asthma, crying in babies etc.

    What sort of evidence would change your mind? Could you be convinced that chiropractic is not working as you believe?

  61. Hey,

    My local quack has now removed the list of treatments for children and also removed all the doctor titles.

    http://www.c3chiropractic.co.uk

    This is good though, under research

    The government of New Zealand published a report which assessed the efficacy and safety of chiropractic care. The report was the result of almost two years of conducted hearings from recognized health care experts.

    Their principal findings included: Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manipulation therapy (spinal adjustments).
    So they found the only people qualified to crack backs where back crackers. That clears that up then and it only took 2 years.

    At least this case has encouraged them to remove the blatant quackery from their advertising. But for how long?

    Wrysmile

  62. If it wasn't then surely. I am not a chiropractor but I have seen results personally for myself and others. The fact that the nervous system does govern the body -spanning the spinal column and out to the periphery is a sound logic to base a health modality on. Where would you be without it and if it's not functioning correctly then a similar scenario before us. I guess at present what sits before me speaks more strongly for chiro than against it and I guess the same is for you Le Canard Noir.
    Research is catching up to what has been known. Perhaps keep an eye out for work by Drs Heidi Haavik-Taylor, Bernadette Murphy, Kelly Holt and Donald Epstein. If I remember any others I'll drop em by. If you have any disproving I'd truly like to see them.

  63. Anaonymous – how are you so sure you have "seen results personally for myself and others". Can you rule out the natural course of the illness?

    The idea that "nervous system does govern the body -spanning the spinal column and out to the periphery is a sound logic to base a health modality on" holds no water. Why? It is typical of the monomania quacks have – latch onto some simplistic idea and then base an entire theory of health on it – homeopaths with their sugar pills, acupuncturists with their blocked chi, reflexologists with their foot thingy. The idea that 'blocked nerves' are responsible for ill health – from back pain to colic – is not plausible – the human body is a little more complex than that.

    I have looked up Heidi Haavik-Taylor and the first study I see is about EEG results before and after chiropractic. Again, a typical quack thing is to extrapolate from these sorts of surrogate measurements (health outcomes were not measured) and then claim some interventional benefit. It's just rubbish research. My blog is full of such nonsensical 'research'. Ms Haavik-Taylor measurements may be all fine and dandy – but you cannot draw health conclusion from them.

  64. Anonymous,

    Your idea that it makes sense to see the nervous system as the cause of ill-health is far too simplistic. It's like assuming your light isn't working because the power cable in the street is malfunctioning. Sometimes it's just a broken light globe (or lung or spleen or heart or ear) and simply bending the cabling isn't a sure sign that the cabling doesn't work properly.

    The very notion that a nervous system that isn't "functioning correctly" is at the root cause of all sorts of ailments smacks of religion. It's like a "God of the gaps" argument where alt-med fills in any gaps that real medicine appears to leave open. "If medicine can't cure it, then (*insert alt-med of choice here*) can."

  65. Le Canard Noir… As for my results, although not scientifically screened. My miagrains went from once/twice a week for 2yrs to none within the first adjustment. Similar with my cousin's asthma and my mother's mentral pain after a week and a half of care. The only factor of change I can possibly put it down to was chiropractic care. Diet stayed the same, netball twice a week continued, environment the same, no medication. You dont know me from a bar of soap and I can appreciate that. Perhaps we are as biased as each other for just as valid reasons.
    My own experience gives me reason to believe in chiro (albeit clinical rather than 'gold standard') and you ask me for evidence yet evidence against chiro isnt anywhere to be found, it seems we both could be ridiculed for a sense of blind faith.
    As for looking up one of the researchers above, its a start for both chiro and you. There's more out there if you take the time and that is the problem. The chiropractic profession hasn't gotten it out there enough. Chiro certainly has not been disproven and if anything the evidence is growing.
    Another resource may be the ASRF (Aust. Spinal Research Foundation).

  66. "As far as chiro goes there's a lot of biophysiological evidence for what they do in terms of musculoskeletal pain"

    Look, Back Quack, I'm really sorry to have to repeat myself, but I have only asked for a very simple answer and it is you after all who have come here to complain about the chiros being called to account. I must say that if you don't want to be labelled as a quack you should not answer one and a classic woo tactic is to avoid direct answers to straight questions.

    Here is my question again;

    "Answer one, just one, question. Please provide unequivocal evidence of the existence of the "subluxations" on which chiropractic is based"

    Now, you may not be a chiro, but you have just claimed to know about their research, so really the obligation now falls to you. And, as a reminder, I don't really care whether you have evidence that back-cracking can make a back feel less bad, though obviously that small claim remains contentious, I only want evidence for the existence of chiros' "subluxations. Nothing else. Do not pass go. Do not collect £200. Go straight to some evidence and report it to us.

    p.s. I have read research, done research, have some stats training, but I'm not wanting a pissing contest based on who has the best qualifications. My side wins automatically and that's not fair, but argument from authority is a rather sad tendency of the woo. I want to see your evidence.

  67. Le Canard Noir: Come on old son you can do better than that!

    In regard to your stating back pain "gets better on its own", yes some back pain does but a surprisingly high proportion doesnt or at the least is recurrent. Of particular interest is the phenomenon of centralisation which appears to involve the posterior dorsal horn of the spinal cord and the amygdala in the brain. This process involves the sensitisation of the central nervous system, so that the pain is no longer tissue specific but is maintained within and by the CNS. This occurs once "acute" pain becomes "chronic", round about 3 months give or take. Thats 12 weeks.
    Now then, given that 70% of adults experience back pain at some point in their lives and even if a fairly high proportion of back pain gets better on its own, there are still a large number of patients whose acute pain becomes chronic and doesnt resolve on its own like you seem to think. These patients clog up the NHS, just ask any GP about the number of chronic LBP patients they're getting who they throw more and more medication at. The NHS have a thing called the Musculoskeletal Severices Framework which states that they intend to get every patient treated within 18 weeks from initial contact….thats about 4 and a half months, well past the point where acute pain becomes chronic. So, you can see two things, that NOT all pain goes away on its own since a fair proportion becomes centralised chronic pain, and that the NHS goals in treating these acute pain patients may actually be contributing towards their chronic status.
    The Framework also includes a directive towards referring LBP patients on to osteopaths and chiropractors via GP to reduce NHS waiting lists. The NICE guide lines also support this view.

    So Monsiour Canard, get your facts right matey.

  68. Andy, Anonymous no more :0)

    There's no reason for this to be too simple. A longstanding malfunction can cause huge repercussions. Build up, atrophy, hypertrophy, excess secretions leading to a cascade of implications, excess growth hormones courtesy, uncontrolled growth (cancer) – all can be a result of a hiccup in the nervous system. Whats happens with MS? Myelin is attacked and destroyed and you know what the signs and symptoms of MS are? Just about anything because of the global effect it has on the body via the nervous system.
    Surgeons treat Raynaud's Disease by cutting out the nerve supply so they no longer recieve messages from the nervous system to over produce sweat and vasoconstrict causing blanching and numbness on the extremities. Perhaps if the nervous system was given the chance to remedy those messages such invasive procedures wouldn't be needed.

    Chiros are just saying that things could be easier and less drastic. Things don't have to be complicated to be a solution.

  69. BSM: *Rolls eyes* Ive already told you i have no idea about the existence of chiro's "subluxations" and dont use that as a theory in practice myself. If you're looking for a fight with a chiropractor go find yourself one.

  70. Back Quack – I am not sure what facts I have got wrong. All I said was back pain fluctuates and gets better on its own. Chirporactors have to show they can actual achieve better results than, say, moderate exercise.

  71. "Build up, atrophy, hypertrophy, excess secretions leading to a cascade of implications, excess growth hormones courtesy, uncontrolled growth (cancer) – all can be a result of a hiccup in the nervous system. "

    You need some evidence for this. Not just handwaving. Of course, there may be specific nervous problems, like MS, but that does not mean you can then generalise to lots of illneses. This is exactly the same mistake homeopaths make – a failure of induction.

  72. BSM…

    I suppose it's curious in the first place that a non-chiro would take the time to offer an alternative view knowing the ridicule this forum guarantees but secondly, subluxtion is only a portion of what chiro is based on.
    If you are going to wait around for research yet to be done on one area of chiro and ignore the rest which has already been done then perhaps thats your own perogative.

  73. Le Canard Noir,

    You are spot on and chiros know it. That research is growing but is sparse in comparison… and once conducted it must reach the public quick smart for a paradigm shift to occur. My point is more that ridiculing chiro due to lack of proof rather than a means of disproving is unjust and may rob the health system of an effective modalty.

    I do appreciate where you are coming from because it is vital to have wholesome research to be accepted into the scientific field and in turn the wider population.

  74. Wow – this is a mind blowing discussion. Interesting how many people are up to fight against any profession in the world that seeks to restore the health of the human body by natural means and not by drugs provided by the pharmaceutical industry, the largest money making scam in the history of the world. Not out to put down the world of western medicine – because I believe that medicine indeed has its place in the world – just not in health. It merely minimises the effects of illness or disease, i.e. symptoms. I guess medicine wasn't rated the number 1 killer in the US in 2004 followed by cancer and cardiovascular disease, without good reason. Just a side note: only 20% of what is practiced in medicine has actually been subjected to the rigorous testing that people are demanding of other therapies….

    Le Canard Noir – [The idea that "nervous system does govern the body -spanning the spinal column and out to the periphery is a sound logic to base a health modality on" holds no water. Why? It is typical of the monomania quacks have – latch onto some simplistic idea and then base an entire theory of health on it]. You have made no attempt to explain how this "idea…holds no water". Anti-chiropractic neurosurgeons, themselves, have agreed that every cell, tissue, organ and system of the body is controlled by the nervous system. It is the first system to be completely formed in the body. Must be a pretty important one – huh? Any system can be disrupted. Your digestive system – constipation. Your cardiovascular system – cardiac arrest. Your respiratory system – lung failure. How is it not plausible and scientifically provable that any neurological deficit can affect our body's ability to function at it's optimum? Do you know anything about neurology? Like the fact that when you hit or compress your funny bone – your ulnar nerve – you can get paraesthesia in your arm. That's your nerve. That's your nervous system. Depending on how early on in the branches the disruption occurs, it can affect many systems. It's a scientific and biological fact. So why does it not make sense to have a profession completely dedicated to releasing interference?

  75. "rob the health system of an effective modalty"

    That is your presumption.

    The point of this whole dispute is that chiropracters are offering implausible treatments. We can simple presume they work – especially when there may be risks associated, or cheaper and proven alternatives.

  76. BSM – you are so eager to find this "unequivocal evidence" for the existence of a subluxation that Chiropractors claim to deal with. I wonder if that's because you think everything in medicine that they claim to consider a disease or disorder has unequivocal evidence? In fact – in a conference on ADHD a couple of years back the specialists from the medical profession admitted that it wasn't a real condition. Look at the number of conditions that they say are idiopathic. No cause. They just made up a disease to clump a group of people together in order to make a drug for them to make money off. An Inquiry into Chiropractic stated that "Chiropractors have reasonable grounds based on clinical evidence for the belief that symptoms can respond beneficially to spinal manual therapy"

  77. The Commission of Inquiry 1979 in New Zealand found that Chiropractic has sufficient scientific validity and that patient testimonies have provided convincing evidence. Of the tens of thousands of patients who have received chiropractic care (in New Zealand) they have apparently suffered no ill effects (New Zealand Commission of Inquiry, 1979, p.77-78).

    Another side note: If what Chiropractors do is such "quackery" – what's with all the medical doctors and other professions performing "spinal manual therapy"? There must be something about what we do that they believe for them to try to do it themselves? And on that note – the Commission of Inquiry also found that "chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy. General medical practitioners and physiotherapists have no adequate training in spinal manual therapy, though a few have acquired skill in it subsequent to graduation"

    The Commission also found that "spinal manual therapy can be effective in relieving musculo-skeleatal symptoms, and other symptoms known to respond to such therapy, such as migraine". And also stated "where there are organic and/or visceral symptoms, chiropractic treatment may provide relief".

    In fact, there have been many studies that have shown that Chiropractic is effective. Not just in the improvements that patients see in their quality of life, but relative to cost. Look at the Jarvis Study and Arlington Study in 1988 that proved that. Chiropractors don't claim to treat or cure anything. They clear the nervous system. The benefits of having a freely communicating nervous system are simply widespread – so it gets quickly associated with "fixing" asthma, backpain etc.

    Grow up. Stop hating on each other. We figured this stuff out in 1979. Stop trying to start a battle that's already been proven and won. We're not going to get anywhere in trying to better the well-being of the world by fighting those that seek to do so.

    Just a question – have any of you that are bagging Chiropractic, ever been under regular chiropractic care? It may be true that we are lacking the so-called "evidence-base" but what do you classify as evidence? Do the 75% of patients that utilise Chiropractic care in the States, that experience the benefits of care in so many facets of their life not count for anything?

  78. I am so delighted we are getting the chiropractors here displaying all the usual quackery canards. You are you own worst enemies. "seeks to restore the health of the human body by natural means" Just brilliant stuff.

  79. Wires control all aspects of my television set. All the best engineers agree on that. When it goes wrong, I give the TV a good thump on the side to dislodge any trapped wires. Always works for me.

  80. Is that all you have Le Canard Noir? All you can do is quote me and say "typical"? I think that says enough in itself.

  81. In my personal experience, people who trot out the usual quackery canards are impervious to evidence and reason.

    For example, do you see that my TV analogy is ridiculous and no one would actually believe that, an yet, similar claims are made for chiropractic? Why is thumping bodies to release subluxations OK, but thumping TVs to release blocked wires a bit daft?

  82. "Wires control all aspects of my television set. All the best engineers agree on that. When it goes wrong, I give the TV a good thump on the side to dislodge any trapped wires. Always works for me"

    You started to vouch for Chiropractic? You've just provided the perfect analogy for what Chiropractors do except they care a bit more for the individual and don't just give "a good thump on the side" although in your case – it would be very tempting.

    By the way – not a Chiropractor. I am a Chiropractic patient of 18 motnhs. I wouldn't be alive today had it not been for Chiropractic care. So if you want to tell me I'd have been better off without it and more than likely, dead. I'd wonder what your motive really is for fighting Chiropractic, or any other natural therapy for that matter. I would prefer a gentle adjustment than pack loading my body full of medication with a QoL close to nil, like I had done for the 10 years previous to Chiropractic.

  83. Excellent. A chiropractor supporter who would not be alive if it was not for [insert arbitrary belief here] and who thinks hitting televisions to fix them is a good analogue of chiropractic 'care'.

  84. "seeks to restore the health of the human body by natural means" – that's a whole sentence for saying "placebo effect", isn't it?

  85. Brainiac – you do not require to label a patient with a specific disorder before treatment. Differential diagnosis of a multiplicity of signs and symptoms is debated and challenged by experienced and competent medical clinicians.
    Is the presentation of a patient with seven symptoms suffering from seven disorders, one significant disorder and two subclinical disorders, none at all as the symptoms exist within the parameters of normality for that specific patient or are the symptoms due to an over-active imagination – on the part of the patient!? Medicine is an inexact science (individual variation, onset, severity, duration and effect + pre-existing and complicating disorders)and frequently treats patients symptomatically with great success without ever knowing the 'name' of the disease or syndrome but in full recognition of the signs and symptoms presented and confirmed.
    I suspect that the bias to conform to politically correct kow-towing, lead too many 'therapists' to label some mischievious children with ADHD and satisfy parents with a physical disorder label (not very politically correct to label some parents with Munchausen by Proxy Syndrome I suspect) – contrary to a significant number of paediatricians and GPs who have always resisted the urge to comply with this nature/nurture fashion statement.
    When you say "no cause" – what you should really consider is no cause yet established. The cause may well be estimated as an educated likelihood or it may have receded leaving the patient with the consequences (injury or disease).
    I suggest that an excellent example of 'clumping groups of people together to make up a disease' as you describe above and then "make money off" is possibly the most astute description of chiropractic tweeking and financial extraction I've read lately.

  86. @Le Canard: Your standards are slipping Sir.

    I may be mistaken but isnt this your own website, or am i just confused by your name? If you did set this place up im surprised that the best you can do in response to the fair and rational arguments put before you by "Curious" and "Chiropractic Rocks…" is to facile ridicule. Are you really not interested in informed debate?
    Must say im more than a little disapointed, i thought this site might be more than just a meeting place for rabble rousing.

    As for "Back Quack – I am not sure what facts I have got wrong. All I said was back pain fluctuates and gets better on its own"

    errr…yep, that'll be the fact you got wrong, right there, riigggggggggggggggghhttt there. Go back and read what i said, back pain doesnt always get better on its own, i clearly told you why.

  87. I guess you might have interpreted my words to mean that back pain always gets better. It just needs to get better often enough to fool the unwary. Its not like, say TB, which does not get better on its own.

    Oh, and informed debate – that requires informed commenters.

  88. Chiropractic Rocks My Socks said…
    "…Do you know anything about neurology? Like the fact that when you hit or compress your funny bone – your ulnar nerve – you can get paraesthesia in your arm. That's your nerve. That's your nervous system. Depending on how early on in the branches the disruption occurs, it can affect many systems. It's a scientific and biological fact. So why does it not make sense to have a profession completely dedicated to releasing interference?"

    Did your chiro tell you that? The interesting thing that thrills me is, why do chiros believe that they can even remotely affect and correct any specific or unspecific nerve by twisting somebody's spine? How on earth can they study(?) for 5+ years *without* finding out where and how the nervous system is located and protected by all sorts of hard and soft tissues??? The muscles may possibly be stretched and massaged, but the spinal nerves? No way! That's physically, anatomically and biologically impossible. The autonomous nervous system is particularly hard to touch from the outside. The only way to affect a spinal nerve without operation or direct injection is to break the back bone, as in an accident with high forces. And the result is, unfortunately, always a loss of function; never have we heard of a nervous disorder being alleviated by a spine-breaking trauma.
    So, in short, to the best of my understanding, the chiropractic claims are implausible. But what do I know, I'm only a radiologist who looks at spines and nerves all days long…

  89. well im certainly better informed on pain management of back pain than you appear to be since you seem to be nervously shifting your position all the time. So when you say "back pain gets better on its own" you actually meant "sometimes" it does, or it "usually" does or "it might do but i really havent done any research into this so am talking out of my arse"? You should be a little more careful with your choice of words because it kind of undermines your credibility.
    …and you know where an inapropriate use of a word or two can lead.

  90. Okihum: They dont claim to "physically" touch nerves through spinal manipulation, the evidence for affecting nerve fucntion through manual therapy including spinal manipulation is to do with neurological communication. A simple example is the Gate Control Theory (Melzack & Wall)in which by externally creating a fresh stimulus to the area of pain one creates a nerve stimulus which blocks the pain in the dorsal horn of the spinal cord. There are soft tissue techniques which involve inhibiting relflex arcs to muscles to allow the muscle to reset its level of contraction and very simple techniques called muscle energy techniques which involve getting a muscle to contract against resistance to relax it before stretching it.
    These all involve communication with the nervous system, not of being able to actually directly manipulate the nerves.

    Hope this makes things a little clearer for you.

  91. I reported our local 'Dr' chiropracter to the Advertising Standards peopel and then set off to complain to the General Chiropracter Council but their web site complaints section is largely inactive doubtless because of our actions. We could win this.

  92. okjhum
    The interesting thing that thrills me is, why do chiros believe that they can even remotely affect and correct any specific or unspecific nerve by twisting somebody's spine? How on earth can they study(?) for 5+ years *without* finding out where and how the nervous system is located and protected by all sorts of hard and soft tissues???

    Yes, I suspect there are sound evolutionary reasons why the brains connections to the rest of the body are buried under several layers of protecting tissue.

  93. okjum said:
    'The muscles may possibly be stretched and massaged, but the spinal nerves? No way! That's physically, anatomically and biologically impossible. The autonomous nervous system is particularly hard to touch from the outside. The only way to affect a spinal nerve without operation or direct injection is to break the back bone, as in an accident with high forces.'

    Really? This is living tissue: a kick in the shin will affect your spinal nerves, it will alter your digestion as you cringe in pain, you might even feel sick or even faint as blood gets diverted all over the place. Tap a tendon with a hammer and what do you think transmits the reflexes, not just to that limb but to all the others?

    Immediately after an unexpected loud noise what happens to your blood pressure, pupil diameter, thought processes and even posture? – yes the startle reflex is a posture change, in the spine, related neurologically via the CNS to metabolic function, how about that, and we haven't even left conventional medicine yet. This has taken a minute so far, manula therapists spend years on this stuff.

    As for the ANS, pressing a rib certainly influences a sympathetic ganglion beneath, and influences the blood and drainage.

    But really, influencing the autonomics is even easier than that, I can do it from here, ALL I HAVE TO DO IS TYPE IN UPPER CASE ISN'T IT?

    And I haven't even mentioned alternative medicine yet.

  94. CRMS

    You said that backcrackery saved your life.

    What fatal ailment did you have which backcrackery saved you from.

    I am agog.

  95. Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.

    Ooopsie

  96. Those who mentioned the Singhe case and the jusgment of justice Eady may be interested to know that November of last year, Eady was attacked for trying to bring in a privacy law “by the back door”.

    “QCs defend Mr Justice Eady as newspapers accuse him of privacy law rulings” (http://business.timesonline.co.uk/tol/business/law/article5126916.ece)– Francis Gibb, legal editor, Times Online.

    For more on this issue, see http://thedukeofurl.wordpress.com/2009/06/11/quackery-discussion-about-chiros-via-quackometer/.

  97. My dear Back Quacker – another common thing i come across when discussing quackery and the quack is on the losing side is to attempt to derail the discussion into irrelevencies and digressions.

    What this means is that you have not addressed my substantive point that anecdote for back pain is useless since there exists a very plausible explanation that it got better on its own.

  98. Coupla tings:

    1. Im not here to win, so this "losing side argument" sounds more like projection on your part. What interests me is constructive discussion rather than point scoring.

    2. Secondly, did you not read my explanation about centralisation in chronic pain? If you did and you understand it then you can see that not all back pain gets better. This isnt anecdotal evidence, i can give you all the trials which support the centralisation of pain, its widely accepted and you still fail to acknowledge it. If you were aware of it you would then realise that you are totally wrong about back pain getting better on its own.

    Im not sure what im supposed to have digressed from this supporting chiropractics assertion that they can cure any old shit was never on my agenda anyway.

    Later.

  99. 1. Chiropractic's method of action is erroneous as described by their own curriculum.
    2. Musculoskeletal manipulation is a sound and accepted form of therapy for – wait for it – musculoskeletal issues
    3. There is a "white coat effect" of having a practitioner attend to your concerns and a following positive effect on pain and well being (this is not precisely a placebo effect but more of a practitioner effect, supported by the tenets of CBT [cognitive behavioral therapy])
    4. Sustained stimulation of the nervous system (qforasong) will have all sorts of results, almost none of which are long lasting.

    The foundation chiropractic medicine is based upon erroneous logic and assumptions, thus all chiropractors are liars.

  100. Citizen Deux: Define "stimulation of the nervous system". Anything which impacts on a person is stimulating the nervous system, from brain surgery, to reading a book to eating an apple, so what exactly are you talking about?

    If you're talking about manual therapy i'm wondering where your evidence is that none of the effects of stimulation of the nervous system are long lasting. Oooops…."almost" none of the effects. So what's the "almost" about? which ones do have a sustained effect?

    The rest of your points 1-3 i essentially agree with but am ignoring your slightly zealous point about "all chiropractors are liars" and putting it down to heady enthusiasm.

  101. Heady enthusiasm is a proper diagnosis – and a bit of provocateur. By stimulation of the nervous system, you are correct. We can affect out bodies (and thus our health) through a variety of stimuli. The problem is that qforasong's comments would indicate belief in a "magical" understanding of the nervous system which permits external manipulation resulting in significant and long lasting effects.

  102. Curious: " subluxtion is only a portion of what chiro is based on."

    Well, no, that's not true. If you don't really have "subluxations" then you don't really have chiropractic. They may not be sufficient to form the fantasy medical therapy that is chiropractic, but they are most certainly necessary. Do you see that? Sufficient and necessary. Two different things.

    Braniac: "you are so eager to find this "unequivocal evidence" for the existence of a subluxation that Chiropractors claim to deal with. I wonder if that's because you think everything in medicine that they claim to consider a disease or disorder has unequivocal evidence? "

    Um…no. Read the posts properly, please. No one is saying that real medicine has perfect evidence for all its therapies, that would be an idiotic position, so please take your strawman away and stand it in a field somewhere it might do some good. I have already explained that your chances of making valid causal inferences are higher if you have higher prior plausibility, or that your evidential requirements can be lowered without too heavily adversely affecting those inferences. That doesn't mean mistaken inferences will not occur, but chiro practic has neither plausibility nor evidence for almost all that it does, so any causal inference about it having positive therapeutic effects are almost guaranteed to be wrong.

    Braniac: " An Inquiry into Chiropractic stated that "Chiropractors have reasonable grounds based on clinical evidence for the belief that symptoms can respond beneficially to spinal manual therapy""

    But without subluxations being demonstrated that means very little. "Spinal manual therapy" is not chiro unless it is founded in subluxations. The fact that some chiros have accidentally entered the world of physiotherapy for sore backs does not retrospectively validate their stupid philosophy and most importantly chiros' arguable ability to relieve back pain does not validate their claims to treat eczema or asthma. What is it with you people? These are not difficult arguments. Chiropractic denies the existence of germs for goodness sake! Do you really want to defend that idea?

    Back Quack: "*Rolls eyes* Ive already told you i have no idea about the existence of chiro's "subluxations" and dont use that as a theory in practice myself. "

    Well you are not well-placed to comment on chiro. Please leave the stage to those who know rather more about it.

  103. Back Quack: " What interests me is constructive discussion rather than point scoring."

    A phrase often used to conceal defeat. When an argument is wrong and is shown to be wrong it has been defeated. The person putting that argument is on what people on this planet call the "losing side". The decent thing to do is acknowledge the error and build it into your worldview. That's called learning.

    You can't meet something that is wrong half-way and make a compromise so that you can call it right. It's still wrong.

  104. Healing the body by natural means = another way for saying placebo? Did you know that 60% of positive patient health outcomes in medical care are attributed to the powers of the placebo effect? So what is the placebo effect? The placebo effect is the measurable, observable, or felt improvement in health or behavior not directly attributable to a course of medication or intervention. So what is it attributable to? The power of the patient's mind and own self-healing body! Because it is more powerful than any other possible intervention, so how is the fact that Chiropractic encourages self-healing a bad thing? So yes, to some extent the benefits from Chiropractic care, of course, are enhanced by the placebo effect – without putting unnatural chemicals into our bodies. Healing by natural means. And might I remind you, without any course of action – the patients would potentially have no improvement at all.

    Count for something?

  105. Too much mudslinging already. I'm afraid both sides of the argument are coming across as bigoted. Perhaps we should look at the bigger "free speech" picture here.

    Chiropractic Rocks My Socks has a good point when he asks why people are targeting the chiropractors rather than the mainstream pharmaceutical industry to task (even if his view on that area of medicine is a little extreme). It seems to me that this is mainly because the British Chiropractic Association has decided to take Simon Singh down rather than the Guardian. Why have they done that by the way? It's beginning to look rather like shooting themselves in the foot.

    I saw both Singh and Ben Goldacre at the Cheltenham Science Festival on Saturday. Goldacre alluded to the larger spectre of what the pharmaceutical industry might be hiding by using similar lawsuits rather than providing counter evidence to accusations from the media. He pointed to the British Medical Journal's three most highly cited articles – one on the adverse side effects of Vioxx and two on adverse side effects of the selective serotonin reuptake inhibitor class of antidepressants that includes Prozac. If these cases exist, could there be more that have been effectively covered up?

    If the Singh case does bring about a shake-up of the libel laws, is it possible we could be thanking the BCA for making it more possible to openly criticise the pharmaceutical industry?

    While I am not going to join in the group kicking that a couple of brave (foolish?) chiropractic supporters are getting there is an element of the McTimoney statement that seems worthy of comment.

    I seem to recall Singh saying that Quackometer had sent a letter of complaint to the GCC's CoP with a big list of chiropractors, only to be told that the complaints had to be filed against each one individually. So with the help of computerized automation that's exactly what was done – which I guess is the 500 complaints. Perhaps other complainants have joined in since – and correct me if my recollection of what Singh said is wrong – but this seems a long way from a witch hunt…

  106. @okjhum "No way! That's physically, anatomically and biologically impossible." – to touch the nervous system? Didn't you QUOTE me regarding the ulnar nerve? Find it. Behind the olecranon of the ulna at your elbow. TOO DEEP? I can squeeze it and make my arm go numb. In fact – in happens every night I sleep on it! If you take a reflex hammer to your patellar tendon – what is it that makes that work? The nerves that are directly attached to that tendon that sends the message to the brain and back. Just as qforasong was saying. Think hard before you post and try to slam well known and scientifically proven facts.

  107. okjhum and Citizem Deux,
    Its curious that you would give such credence to the concept of mind over matter yet not give the constant statistics and research given to you on this forum a nosey.
    The placebo effect and in turn the 'white coat effect' have a special consideration in every single scientific trial because it is deemed to cure people of their illnesses. The question is why is this not being researched and explored as a health avenue? Because there is no money it. If people can be better of their own accord then drug and medical enterprises go down.

    Le Canard Noir, why have you said nothing about what CRMS has quoted about America's number one killer to be allopathic medicine yet seemed to be coming down on the chiro profession for what eaxactly? Not having enough research? I dont think that is sinister enough by comparison with your siding.
    They speak of a chiropractic stroke which is also hugely heresay. In the Commission of Inquiry, as Wrysmile so kindly brought up, it reads 'The conspicious lack of evidence that chiropractors cause harm or allow harm to occur through neglect or medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record.' p.80, Chpt 15

  108. Fatal ailment? I did not claim to have a fatal ailment – I just claimed that Chiropractic saved my life. Without Chiropractic care I would have most likely successfully killed myself from all the pain I had been in – leaving me bedridden for two-thirds of my waking life for 10 years or so, even though I was taking Codeine every 3 hours. No-one could find a cause or a cure. I only started getting Chiropractic care because it was free for me. I didn't think it would even work. So you can minus the placebo effect. I hate claiming to be a pain patient – because Chiropractic isn't about pain – but I am the healthiest I've been in the 24 years I have been alive, and medication free. I haven't changed anything else in my life. I can only attribute my improvements through the power of Chiropractic to allow my body to be interference free and self-healing. I don't really care if you want to give that any credit or not – but the very fact that I am sitting here write now writing about this is enough credit for me to believe in it.

  109. The reason I have not mentioned " America's number one killer to be allopathic medicine" is because it is one of the delusional canards batted around by quacks who would not know evidence if it slapped them in the face with a bag of wet fish.

  110. If you delve a little deeper BSM you will find that chiropractors do not deny that germs even exist. Of course they exist. That cannot be denied. What they refer to is the germ theory. The Germ theory is based upon one who exposed to a certain 'germ' will then exhibit a certain 'disease'. The chiro stance is that why is it when a group of people are exposed to the same germ do only some end up with the disease? The point being that there is more to health and the human body than the germ theory gives it credit for.
    It is almost ironic that Andy should bring up the fact that the chiro theory is 'far too simplistic' when such modelas as the germ theory (which is indeed the greatest basis in which bio-med holds itself upon) deem health as a simple this + this = that when in truth it is far more than a two part equation.

  111. I LOVE CHIROPRACTIC! DOO DAH DOO DAH. The millions of chiropractic patients around the world that continue to use chiropractic and pay money to do so are evidence of the fact. Perhaps not scientific evidence – but evidence nonetheless. Did you know that most "chiropractic adjustments" that have caused harm which are reported in articles are 90-95% of the time given by medical doctors and not chiropractors? Just thought I'd chuck that one out there.

  112. The circus has arrived in town.

    " millions of chiropractic patients around the world that continue to use chiropractic and pay money to do so are evidence of the fact"

    that millions of people have been taken in by this cult?

  113. Perhaps you are simply respeonding to keep your thread alive Le Canard Noir… I couldn't be sure but it seems a response to you is no longer needed.
    Thank you for a hearty discussion.
    No doubt see you back here at a later date.

  114. Le Carnard Noir – I have no idea what your qualifications are. But it is evident that you have absolutely no intention of seeking what the real truths are. You have made no attempt to acknowledge any of the hard facts that are in favour of Chiropractic. Maybe you should seek to understand the fact that all that Chiropractic is about is having a world of people functioning at their optimum and trusting in their bodies' ability to self heal. We do not deny the usefulness in medicine or physiotherapy (which might I add, was once upon a time seen as "alternative") and have no purpose other than to serve the people of the world. I must say it saddens me that you donate so much of your life to slamming the "quacks"…

    All the best Le Canard Noir.

  115. I have no doubt that chiropractic is about people bodies ability to self heal. I just object to you charging £60 a pop while it gets on with it.

    Your 'profession' is being exposed. And about time too. It is up to you whether you want to continue to defend implausible and disproven therapies or emerge with a new approach. There are a few of you out there willing to confront this new reality. My guess is though – not enough.

  116. Chiropractic Rocks My Socks wrote:
    Chiropractic is about is having a world of people functioning at their optimum and trusting in their bodies' ability to self heal

    That is just such meaningless twaddle. And I do believe you have never read anything that purports to be chiropractic research. Or if you have then I expect you don't understand it.
    I refer you to the publication, Anglo-European College of Chiropractic Research and Postgraduate Studies, Academic Years September 2005 to August 2007, which you can find here along with a couple of other similar publications. Look for this trial: Comparison of the Short-term Effects of Two Chiropractic
    Techniques in the Treatment of Infant Colic: a Singleblinded,
    Randomised Trial
    and marvel at the shoddiness. No double blinding, no placebo control, no evidence based therapy to compare… Just two unevidenced therapies compared in a single blinded (might as well be unblinded) trial to see if one is "better" than the other. This is typical example quack "research" done in such a way as to look like real objective research. It provides evidence for nothing and it is presented in such away as to distract from its pointlessness and irrelevance to anything.
    The other thing I should say is that the only things for which there exists any evidence for chiroquack therapy can equally if not better, and certainly cheaper, be done by a qualified physiotherapist (who will not put you endanger of having a stroke by twisting your neck, nor blather on about subluxations, nor "fix" you up with a plan for "maintenance" revisits).

  117. BSM: you strange little man, you seem to have invented an arguement with me about chiropractic subluxations, which i have had no interest in discussing with you at any point. Yet you still insist on banging on about them as if i could give a shit.

    Not really sure why you're so bothered about winning or losing, is this why you come here?

    My only interest in this place is to discuss evidence or lack of for manual therapy, im sure you dont need anyone to answer your question about subluxations, since you evidently already know the answer. So why keep going on about it?

  118. PVANDCK: I havent seen this trial but just out of interest, how do you suppose one would construct a double-blinded trial on spinal manipulation?

  119. pvandk: you seem anaware that plenty of physio therapists use spinal manipulation as a matter of course. Its not taught at under graduate level but huge numbers do it post grad. The main complaint i hear from patients coming to my osteopathy clinic is that physios barely touch them at all. The emphasis is far more on re-hab which can often only go so far. I agree physio is cheaper because its on the NHS and also that many (not all) chiropractors are crooks the way they convince people they need ongoing treatment when they are symptom free thus pathologising perfectly well people.

    Keep up the good work.

  120. “I havent seen this trial but just out of interest, how do you suppose one would construct a double-blinded trial on spinal manipulation?” –Back Quacker.

    pvandck's comment struck me as rather odd too – I've never bothered to look at the research methods and evidence for this sort of thing before either 😛 – but the answer can be found here:

    “Double-blind was defined as blinding of both the patient and the evaluator as to treatment allocation; in such studies the therapist had, of course, to be unblinded.”

    http://www.jpsmjournal.com/article/S0885-3924(01)00337-2/fulltext

  121. Curious: "If you delve a little deeper BSM you will find that chiropractors do not deny that germs even exist. Of course they exist. That cannot be denied. What they refer to is the germ theory."

    Yes. My bad. In that post where I wrote "germs" I should have said "germ theory". Any fool with a microscope can see a germ.

    Which does not alter the basic point.

    It's one of those "necessary and sufficient" things again. Only an idiot would say that it is sufficient to have a germ to have a disease. Even rabies needs a route into the body to kill you. It's not going to leap from a high-security lab, burrow through the wall and infect passers-by.

    The fact that there are variations in susceptibility to disease is also not controversial.

    The problem arises with chiro, as with a lot of alt.med., when claims are made implying that a particular therapy is capable of radically altering patient susceptibility. Chiro's originating claims are at the far, wild and wacky end of that spectrum where it is all to to with the body's "innate healing" ability, or lack thereof

    http://www.ncbi.nlm.nih.gov/pubmed/11619007

    No one can reasonably say that you should not "strengthen your immunity to protect from disease". The problem arises when one asks, a. what exactly does that mean and b. does the particular therapy achieve that end?

    I have a challenge if you can round up a hundred chiros. Let's inject 50 with Ebola and 50 with rabies. I don't think we need a control group just this once. Let them crack each other's backs as much as they like. We may need to call in other chiros to do the cracking once the numbers of survivors starts getting a bit low. If they all survive then chiropractic's theories are right.

    As I have posted and reposted, chiropractic is founded on a lie. The chiropractors have found no way to separate themselves from that lie. Instead they have garnered public and regulatory respectability without ever having had to deal with the rot at the core of their therapy. Now is the time for them to deal with this honestly and openly. Unfortunately, the MCA's actions speak rather more of a desire to cover up and hide the problems. This does not bode well.

  122. OK, Back Quacker, to sum up.

    1. You have sought out a blog post specifically about a chiro club requiring its members to take down therapeutic claims that are not substantiated by evdence. This is against a background where chiros under under attack specifically for making claims to do with things other than back pain.

    2. Your first post made a rather foolish and illogical tu quoque attack on normal medicine.

    3. You then erected your strawman and put him up for all to see, "What i do know is that there's quite a bit of evidence showing that spinal manipulation is more effective and statistically much safer for low back pain than NSAID use."

    The issue is not "spinal manipulation for low back pain" it is chiropractic spinal manipulation for anything but low back pain.

    4. You have no evidence for the "subluxations" on which chiropractic was founded, but still you have spent your own time to come here to be antagonistic to an attack of chiropractic's wild claims by choosing to attack proper medicine. Let me repeat, the discussion is not about back pain and physical therapy for it. We all perfectly happily accept that despite their faulty theoretical underpinnings, the chiros may manipulate backs in such a way that an incidental effect is that they relieve back pain no less badly than other therapies, though we also have to be reminded that they kill a few patients, where the risk of the latter is not acceptable given that there are ways to treat those patients that avoid the risk altogether.

    We are complaining about chiro's claims to treat every other medical conditions based on their fallacious theory, so that given there is zero likelihood of them having a genuine therapeutic effect, even if the number of patients they kill is really tiny, their risk:benefit ratios still tends off to infinity.

    5. "BSM: you strange little man, you seem to have invented an arguement with me about chiropractic subluxations, which i have had no interest in discussing with you at any point."

    If you are not interested in discussing subluxations, you are not interested in discussing chiropractic, especially in connection with its wilder medical claims. As I have just said, you have effectively disqualified yourself from comment on the subject of this discussion.

    6. "My only interest in this place is to discuss evidence or lack of for manual therapy,"

    Fine. Maybe you don't need evidence for subluxations to discuss the evidence for positive effects for manual therapy. Maybe the chiros have hit another flukey bullseye by being able to cure asthma by cracking backs even though their underlying theory is mad. You want to discuss evidence for manual therapy. Show us some (high-quality) evidence that it is efficacious against asthma and infectious disease.

    For further clarification, in case the point has not been adequately made yet. This discussion is not about back pain. No one is particularly complaining in the context about chiros' claims to treat back pain. There are plenty of other places to defend NICE's recent decision to admit acupuncture and spinal manipulation for that specific indication, but this is not it and the more you persist in trying to discuss only back pain, the less it looks like an irrelevant derailing of the topic in-hand and the more it looks like the usual woo game of trying t throw sand in the eyes of critics. As an osteopath, you have a major interest in not being counted among the woos. In that case, you need to stop using their tactics.

  123. @BSM: "No one can reasonably say that you should not "strengthen your immunity to protect from disease". The problem arises when one asks … what exactly does that mean … ?"

    On my way in to work I regularly see adverts for supplements with claims about "supporting/strengthening the immune system" or similar. I haven't bothered to report any to the ASA because I suspect the claim is so vague as to be meaningless.

  124. Back Quacker – the osteopaths have a little grace time at the moment and if I were one I would be thinking hard about where I want my profession to be. You have quite clear choices – you can throw your lot in with the chiroquacktors and (probably) go down with them, or you can reassert your profession as a responsible, evidence based mode of therapy.

    There is little evidence that the osteopaths are taking this opportunity. I know of only one who is openly prepared to have this discussion, Jonathan Hearsey, and my guess is he is none to popular for bringing these issues up.

    Osteopathy is riddled with quackery at the moment – one day, limelight will be thrown on nonsenses such as cranial osteopathy. Will the osteopathic profession also show themselves to have no backbone like the McTimoneys? Or will you start putting your own house in order in your own time?

  125. The pseudo-ironic flounce is another familiar woo tactic to evade awkward questions.

    I imagine it to be accompanied by the same look my cat wore when his showing off on the shed roof culminated in a messy and ungainly plummetting onto the grass whereupon he stalked away trying hard to give the impression that that had been what he had meant to do all along.

  126. Le Canard Noir: Yes i know Jonathan and his blog, but he's by far the only osteopath attempting to treat from a strong evidence base. He's perhaps one of the few with a visible online presence though, so perhaps thats why he's the only one you've heard of. In terms of Osteopathy putting its own house in order, i totally agree with you, this is a great opportunity for osteopaths to learn from the huge mistake and mismanagement of chiropratic and to re structure their Osteopathic Framework. Having attended the regional meeting of the General Osteopathic Council last week it appears they are doing exactly that. It should be interesting to see how this restructuring works. The fact is though, that cranial osteopathy will be included so they obviosuly arent going to base ALL the changes on sound evidence. This will leave osteopathy open to continued ridicule from certain quack bashing areas. All i can do is attempt to have an evidence informed practice, if only for the sake of a clear conscience.
    Anyway, this site isnt about osteopathy, nor evidently about back pain. So i'll leave you all to it, its been a pleasure.

  127. Simon still has a huge legal mountain to climb and it is far from certain he will win.

    However, win or lose, what is quite clear is that huge reputational damage is being done to the chiropractic trade. If I was in the BCA, I would be very keen to know what the BCA hope to salvage from this from continuing the case.

  128. I'm quite happy to see an Osteopath any day here on the left bank of the Atlantic. They have homogenized quite will into the mainstream scientific medical community. What's up with Osteopaths in the UK?

  129. Well, from what I understand, there is a huge difference between an osteopathic physician (US) and an osteopath (UK). One has had a lot of training, the other thinks they have had a lot of training.

  130. A very nervous 'Hello to all' from the wings (or the fringe if you like).

    Keeping this on topic I thought I'd link to this…

    http://www.chirobase.org/07Strategy/goodchiro.html

    @ Anon (there are SO many) – if UK Osteos started making claims like the US Osteos then Google would be trying to buy a certain website from a certain Mr. Lewis as I feel that my fellow sceptics would hit his site more than they Twitter.

    I'm off to from whence I came…watching events with great interest though.

    JH

  131. The training of an osteopath in the UK is 4-5 years and covers anatomy in greater depth than medical students, physiology, pathophysiology, a bit of pharm, tiny bit of psychosocial and lots of osteopathy. In america osteopathy has been absorbed into mainstream medicine to the extent that most american osteopaths aren't manual therapists any more. If you dont want to go and have manual therapy then go and see an american osteopath, if you have non-specific back pain then manual therapy, (with guidence on exercise, life style and posture etc. All stuff that osteopaths are generally pretty good at) is more effective (and yes, there's lots of evidence)than usual medical care. This is what UK osteopaths do. Obviously there are lots of osteopaths out there who may claim to help with a lot more than the muscoloskeletal system, but generally the training at undergraduate level these days focusses on the MSS.
    If you are looking for manual therapy i dont know of a better training than osteopathy. Does anyone else?

    (I wasnt going to come back here and keep posting about osteopathy and back pain but since i saw my tribe being attacked….)

  132. "The training of an osteopath in the UK is 4-5 years and covers anatomy in greater depth than medical students"

    What did I tell you?

  133. I think the burden of proof perhaps lies the other way around.

    Osteopathy students may well spend time in 'anatomy' classes, but anyone who come out of that believing such things as cranial osteopathy obviously has not had anything like real training in the human body.

  134. you're confusing anatomy with physiology, structure with function.

    anyway, i'm retiring from my short usage of this site…off to write dissertation.

    happy quack bashing

    Bye.

  135. I am not so sure I am the one with the confusions.

    Anyway, my head is throbbing now and I am sure you could feel it.

  136. Sorry for being late (have been on call)
    Back Quacker said (11 June, 2009 17:05):
    "…There are soft tissue techniques which involve inhibiting relflex arcs to muscles to allow the muscle to reset its level of contraction and very simple techniques called muscle energy techniques which involve getting a muscle to contract against resistance to relax it before stretching it.
    These all involve communication with the nervous system, not of being able to actually directly manipulate the nerves.

    Hope this makes things a little clearer for you."

    Sorry, no, just bewildered on a higher level. You describe working with muscles. I was talking about spinal roots. (Some other time you may want to define "level of contraction" and "reset" and the route & mechanism of that resetting.

  137. qforasong said (11 June, 2009 17:17):
    "…a kick in the shin … Tap a tendon … an unexpected loud noise … pressing a rib … TYPE IN UPPER CASE…"

    Did you just exemplify chiropractic techniques?

  138. "I can only attribute my improvements through the power of Chiropractic to allow my body to be interference free and self-healing."
    "The millions of chiropractic patients around the world that continue to use chiropractic and pay money to do so are evidence of the fact."
    So why is it impossible to show scientific evidence of it in well-designed research? If n=millions it surely would easily reach statistical significance even if there was only minimal clinical significance. But it seems to lack even that. Why am I not surprised…

  139. "Did you know that most 'chiropractic adjustments' that have caused harm which are reported in articles are 90-95% of the time given by medical doctors and not chiropractors?"
    – No, I didn't know. References, please.
    And shouldn't it be "100% of the time", since chiros don't seem to admit any harm at all?

  140. Okjhum:
    Muscle Energy is an Active (requires patient utilization of force) Direct (engages the barrier) technique that promotes muscle relaxation by activating the golgi tendon reflex. It's also been proposed that temporary muscle fatigue blocks reflex-contraction and allows for an increase of range of motion to beyond the barrier.

    Purpose is to gain motion that is limited by restrictions of neuromuscular structures.

    Reciprocal inhibition:

    Reciprocal inhibition uses the body's antagonist-inhibition reflex to induce relaxation of a "tight" muscle. For example, when the biceps (in this case the agonist) is flexed, a reflexive inhibition of the triceps (here the antagonist) is induced. Thus loss of range of motion in the triceps can be incrementally restored by flexion of the biceps.

    Post-isometric relaxation:

    Immediately after isometric contraction, the neuro-muscular apparatus becomes briefly refractory, or unable to respond to further excitation. Thus, stretching a muscle immediately following its isometric contraction may incrementally restore range of motion.

    So thats a brief explanation of a manual therapy technique which influences the nervous system via muscles, and vice versa.
    Its really very straight forward.

    In terms of your thinking that spinal manipulation affects spinal nerves directly, by in some way mechanically stimulating them, well i think you are misunderstanding things slightly. I doubt any spinal manipulator would think they were doing this. There may well be an effect on the golgi tendons in the muscles around the associated spinal level being manipulated and that may result in changing the tone of the surrounding muscles post -manipulation. It's also possible, though ive yet to see any evidence in writing, that by improving the afferant input to a sensitised posterior dorsal horn of the the spinal cord, that the centralised pain may reduce. This is after all what they attempt to do with drugs and with CBT in pain management clinics. In theory, either via descending influence from the higher centres of the CNS or via peripheral stimulation, theroreticaly the plasticity of the central nervous system should allow for sustained improvment.
    So spinal manipulation is one possible tool amongst many which may achieve this.

  141. Heya Guys,

    I had a little think bout whats going on in this forum and it kinda seems like those of us that support chiro (and co) feel like your missing a vital piece of understanding and you feel like we are missing something. It's definitely a 'us vs you' kinda thing.

    Is it the lack of research predominantly? Or is it something else?
    I'm finding it difficult to understand why there is such a negative stance relative to chiro here when. A lack of research just doesn't seem to account for the animosity.
    Is there a level of damage which chiros are responsible for which I am unaware of because I'm not in the UK?

    Cheers Guys

  142. @ okjhum:

    ""Did you know that most 'chiropractic adjustments' that have caused harm which are reported in articles are 90-95% of the time given by medical doctors and not chiropractors?"
    – No, I didn't know. References, please.
    And shouldn't it be "100% of the time", since chiros don't seem to admit any harm at all?"

    I think Anonymous's confusion here may result from the fact that the vast majority of adverse reactions are reported by the doctors who the patients have been seen by afterwards rather than by the chiropractors. For example, Edzard Ernst carried out a survey of neurologists, asking if they had seen neurological complications within 24 hours of cervical spine manipulation, and found 35 cases.

    http://www.ncbi.nlm.nih.gov/pubmed/11285788

    In a talk he gave to the Medico-Legal Society in 2006 Ernst noted that under-reporting of these cases was 100%.

  143. Here's hoping that one day all of you will suffer from chronic pain that can not be dealt with by conventional medicine. Lets see how sceptic you all are then when you roll into a chiro clinic. Has anyone ever had a treatment or understand what its about. Patients are evidence in themselves, would they really return and pay for a bogus treatment, at approximately £35 a treatment, I THINK NOT !!!!!

  144. Well, the answer to that is obviously yes.

    Let me tell you about my own untreatable chronic pain – back pain. It comes and goes. Sometimes it is quite bad. Over the years it has got a lot better so that now I hardly suffer at all, Maybe after gardening or something. Ten years ago – agony.

    If I believed in chiro I would have gone when my pain is bad. Days/Weeks later it would have gone – thank you chiro! Here's your money!

    It is very easy to get suckered into the belief that it is the quack (of any pursuasion) that is doing he healing.

  145. Le Canard Noir: Yes i understand this point very well and it's partially true, since a lot of pain is self-limiting (if you scroll back, ive explained that not all back pain does self limit and why), but the conventional thinking about chronic pain is that it is virtually untreatable. It tends to come and go like you say, in acute episodes. Most people want some help managing these acute episodes and manual therapy is pretty effective i find. With a chronic pain patient i wouldnt expect to permanently "cure" them of their pain, this would be naive, but working out the best way for them to manage their pain, via osteopathy/chiro, exercises, postural advice and education on back care and chronic pain neurophysiology is a sensible and rational approach.
    In my experience these patients are happy with this approach and it gives them some relief, and thats all we're after.
    It is entirely possible that your initial acute pain has now become chronic because you didnt get it treated during the acute phase (see my post on acute-chronic pain), if this is the case its a pity that your entrenched views have presented you with a life time of grumbling back pain. A prime example of the head ruling the body.

  146. And this is what makes you a back quack – you want it all ways. "Chronic back pain is incurable" – "You have chronic back pain because you didn't get it treated"

    Well, I don;t have chronic back pain – my back pain is probably much like anyone else's now. Occasional and not serious.

    The trick is for back quacks is to show what the do actually does alleviate pain or even makes it get better over time. The evidence is weak to date. Not back for a hundred years of cracking backs.

  147. well said.. Mr Noir who diagnosed your condition as untreatable, you????Brought on by gardening let me guess you suffered from low back pain???? You may think it has got better but it will come back and when it does it will be worse than ever.. enjoy !!!! To educate you further chronic has nothing to do with the intensity of pain that you experience. There is acute, sub-acute and chronic, they pertain to the length of time the pain has been present, someone with acute pain can feel the same amount/ or more pain than someone with chronic pain. Another indication of your lack of knowledge leading you to such sceptism!!!!

  148. Oh Ducky!

    I suggest a couple of things:

    1. Read more carefully what i write and count to 10 before sticking your foot in your mouth once again. You see, chronic pain doesnt work like you think, chronic pain isnt always a constant pain, its often marked by its acute phases (ive explained this to you already). The way it works is that your dorsal horn has been sensitised so that, now, when you get back pain, its usually in the same place, this is caused centralisation. Im glad you dont get much back pain anymore, thats great, but you still sound like a chronic pain sufferer. Again, as ive already explained to you, acute pain lasts up to approx 3 months (debatable) and after that is chronic and centralised. The accepted way of avoiding pain becoming chronic is to treat during the acute phase.
    This is the latest, accepted view on acute and chronic pain. This is how it works. This is what is now being taught to GPs, anesthetists, nurses, neurosurgeons and physios, are they all "quacks" too? How do i know? Because ive sat next to them for the last two years doing my Pain Management MSc in Cardiff University.
    The latest approach in pain management being adopted by the medical world is the biopsychosocial model. Treating all aspects of the person in managing their pain. Osteopathy , (and not just "back cracking") is one effective method.
    The way you respond, honestly makes it very clear that you have very little clue about how pain works and the neurophysiology underpinning it. It undermines your cred old boy.

    2. Go buy a neurophysiology book, do some reading and ejumacate ya self.

  149. Oh Ducky!

    I suggest a couple of things:

    1. Read more carefully what i write and count to 10 before sticking your foot in your mouth once again. You see, chronic pain doesnt work like you think, chronic pain isnt always a constant pain, its often marked by its acute phases (ive explained this to you already). The way it works is that your dorsal horn has been sensitised so that, now, when you get back pain, its usually in the same place, this is caused centralisation. Im glad you dont get much back pain anymore, thats great, but you still sound like a chronic pain sufferer. Again, as ive already explained to you, acute pain lasts up to approx 3 months (debatable) and after that is chronic and centralised. The accepted way of avoiding pain becoming chronic is to treat during the acute phase.
    This is the latest, accepted view on acute and chronic pain. This is how it works. This is what is now being taught to GPs, anesthetists, nurses, neurosurgeons and physios, are they all "quacks" too? How do i know? Because ive sat next to them for the last two years doing my Pain Management MSc in Cardiff University.
    The latest approach in pain management being adopted by the medical world is the biopsychosocial model. Treating all aspects of the person in managing their pain. Osteopathy , (and not just "back cracking") is one effective method.
    The way you respond, honestly makes it very clear that you have very little clue about how pain works and the neurophysiology underpinning it. It undermines your cred old boy.

    2. Go buy a neurophysiology book, do some reading and ejumacate ya self.

  150. You really are a patronising little fuck aren't you? Of cousre i know chronic pain need not be constant. My point is not to lecture you about pain – I need not explain every last detail – but to make a point that cycles of pain may result in a person believing a treatment is effective. it is called regression to the mean. But instead of addressing my central point – which i believe was clear – you go off into word wank mode. So tedious.

  151. heh heh

    You're funny.

    But really its a pity you have to get abusive, i just felt you were judging manual therapy's approach to pain management without actually having much idea how pain management works. You have set up this site to exercise your biased agenda and are evidently unable to bare someone pointing out holes in your argument. Well now I've sussed what you're about i'll leave you to it.

    Sleep well Ducky.

    Good luck with your pain.

  152. I do indeed have a biased agenda. My biases are against misinformation, pseudo-science, exploitative practices and the abuse of science and evidence. Welcome to my site. Drop by any time!

  153. The reason I ask is because in the states was a legal battle called 'The Wilk Trial' which started in 1976.
    Dr Chester Wilk discovered he was under surveillance for no apparent reason. This lead to leaked info and the discovery of a 'Committee on Quackery' set up by the American Medical Association (AMA) due to chiro becoming the largest growing drugless health profession. This committee was set up to soley to eliminate chiropractic as a competitor to medicine and each MD had to swear never to endorse Chiropractic. The trial sort to prove that there had been intent to eliminate competition, that they had implimented intent with action and had been successful in the elimination.
    Chiros lost the first trial whilst the Osteos, Chicago Med society, Illinois Med society and American Academy of Phys therapies and Rehab society settles out of court.
    There was then a retrial in 1987 due to 'Massive Error' of the initial trial and in the end $20 000 000 was paid by the AMA to the chiros.
    The Documented Facts

    1. Spinal manipulation was found by the U.S. Government to be therapeutically superior to medicine for the care of low back pain. It's superiority is also supported by government studies from Canada, Great Britain and New Zealand.

    2. Chiropractic is found to have more scientific research to support what it does than does medicine.

    3. An internationally renowned medical professor and author found that a chiropractic college he visited had superior facilities to any medical school in America that he has ever visited­­ and he's visited most of them.

    4. A medical journal survey found that chiropractic patients enjoy a three time better patient satisfaction ratio over medical patients.

    5. State workers' compensation studies show that chiropractic is more cost effective by as much as a 10 to 1 ratio over medical patients.

    6. Chiropractic care is proven to be much safer than medical care.

    7. 90% of the chiropractic patients polled found that chiropractic was therapeutically helpful.

    The second point is by far the most fascinating.
    So, I only ask because I am curious as to whether this is your own and well researched opinion?
    Or whether you are victims of a lack of individual opinion and subject to a mass conspiracy still yet to be completely eliminated?

  154. Er…

    "If you take a reflex hammer to your patellar tendon – what is it that makes that work? The nerves that are directly attached to that tendon that sends the message to the brain and back. Just as qforasong was saying. Think hard before you post and try to slam well known and scientifically proven facts."

    The knee jerk (it's something I do a number of times per week in my hospital-based tertiary neuropsychiatric practice) is a monosynaptic stretch reflex as far as I know. They send the message to the cord, and then back. The tendon reflex is different, and polysynaptic, but doesn't get beyond the cord.

  155. For an amusing digression, enjoy this site:
    http://www.atlasprofilax.ch/eng/faits.php
    It says, "Did you know that the first cervical vertebra – the atlas – is completely dislocated (luxated) in most humans? And that this circumstance leads to a variety of physical and psychological ailments and illnesses, which can definitely be corrected … … The dislocated atlas is the main cause of dysfunction in the body and the psyche, of pain, disability, infirmity, and degeneration."

    Aren't they being a bit modest? I'd frankly say that the completely dislocated atlas may be a main cause of the death of that rare person who had it…

  156. This is fantastic.

    I may have missed it and I'm just wondering, but has anyone made PrintScreen or (Firefox app) FireShot images of the (Google cache) pages?

    I believe, after a while, they will go the same way as the blocked web.archive pages, so someone should probably copy them (and if they save the Google cache copies, they'll be kindly time-and-date-stamped by Google, to prove when they were online).

    I would, but I've got a wad of nationalist propaganda polluting my computer. (I battle history quacks.)

    Thanks and good luck!

  157. "The way it works is that your dorsal horn has been sensitised so that, now, when you get back pain, its usually in the same place, this is caused centralisation. Im glad you dont get much back pain anymore, thats great, but you still sound like a chronic pain sufferer. Again, as ive already explained to you, acute pain lasts up to approx 3 months (debatable) and after that is chronic and centralised. The accepted way of avoiding pain becoming chronic is to treat during the acute phase.
    This is the latest, accepted view on acute and chronic pain. "

    and for all therapies, whether conventional or quacky, giving good narrative is part of the treatment.

    The trick is to show whether your own particular modality gives anything more than good narrative. Especially for something like back pain where it may be an effectively permanent, though fluctuating condition, the really tricky thing is that people's perception of their own problem can be manipulated more easily than their spines can be. That is not necessarily a bad thing but no one should fool themselves into thinking their therapeutic modality has specific benefit if it only and solely gives the patient a new perspective that lets them live better with their problem.

    This is where those of us who demand evidence can meet the quacks, if not half-way, at least someway into the intervening gulf- we accept you can give patients a narrative that in turn gives them a sense of power over what may actually be an intractable problem, particularly if the patient has inflated that problem to be a major focus of their life. The trouble is that the quacks have so much of their own lives vested in their personal form of magic that as we approach them making simple and reasonable points it is to be greeted by the sight of them fleeing in the opposite direction clutching their toys to their chests and crying about nasty people were being horrid to them.

  158. "The way it works is that your dorsal horn has been sensitised so that, now, when you get back pain, its usually in the same place, this is caused centralisation. Im glad you dont get much back pain anymore, thats great, but you still sound like a chronic pain sufferer. Again, as ive already explained to you, acute pain lasts up to approx 3 months (debatable) and after that is chronic and centralised. The accepted way of avoiding pain becoming chronic is to treat during the acute phase.
    This is the latest, accepted view on acute and chronic pain. "

    and for all therapies, whether conventional or quacky, giving good narrative is part of the treatment.

    The trick is to show whether your own particular modality gives anything more than good narrative. Especially for something like back pain where it may be an effectively permanent, though fluctuating condition, the really tricky thing is that people's perception of their own problem can be manipulated more easily than their spines can be. That is not necessarily a bad thing but no one should fool themselves into thinking their therapeutic modality has specific benefit if it only and solely gives the patient a new perspective that lets them live better with their problem.

    This is where those of us who demand evidence can meet the quacks, if not half-way, at least someway into the intervening gulf- we accept you can give patients a narrative that in turn gives them a sense of power over what may actually be an intractable problem, particularly if the patient has inflated that problem to be a major focus of their life. The trouble is that the quacks have so much of their own lives vested in their personal form of magic that as we approach them making simple and reasonable points it is to be greeted by the sight of them fleeing in the opposite direction clutching their toys to their chests and crying about nasty people were being horrid to them.

  159. Sorry if someone has pointed this out already but in my yellow pages are chiro adverts making claims about collic.

    Not so easy to taek down I think.

  160. @Le Canard Noir: Calling your interlocutor a "patronising little fuck" might make you feel better but it doesn't advance your argument one iota. Stick to the facts.

  161. WOW…..I'm absolutely flabbergasted at the complete lack of real information on here! BackQuacker is the only one actually trying to put forth a reasonable argument in favor of spinal manipulation…and he/she isn't even a chiropractor!!!!

    Here goes….I'm an American (yankee) chiropractor. I practice in Maine with a small, busy office.

    Since there's so much bullshit on here (about 90% of these posts), let me take a small whack at this. Short answers for you Brits….

    1) DC's are REAL doctors. In the US, we take as many course hours of instruction as MD's, and have to pass rigorous national board exams. The gov requires continuing education and practice audits.

    2) The subluxation theory is old and archaic, and I'm sorry you Brits haven't caught on yet. I don't consider spinal misalignments to be the root of all ailments, nor the cure for all diseases. That would suffice as quackery. HOWEVER, I do know that an inflammatory state within the nerve root complex at the spine (think prostaglandins/leukotrienes) causes a subtle loss of axonal transference, which interferes with mechanoreceptor/proprioceptive afferent input to the CNS. Therefore, if you do something (hence, manipulation) to the spine to aleviate the mechanical aberrance creating the inflammatory state, the person gets better.

    Got it so far? Am I going too fast?? Let's keep going….

    3) Chiropractic for children? SURE! They have spines too, don't they? As far as the need for manipulation, if a child gets injured or has mechanically-based musculoskeletal problems, then common sense would tell you chiro can help them too, just as it does for adults. As for ear infections, colic, asthma, enuresis (bedwetting), etc……well, it depends on the child. Some respond well, some do not. Clinical evidence shows a great satisfactory rate for these things, just ask any DC. There is some research to show that chiro helps with these ailments (look up JMPT, JACA, or SPINE journal), but admittedly we need far more to calm the naysayers.

    4) Placebo effect? Oh, c'mon…….while the placebo effect can actually have a legitimate place within healthcare, it doesn't explain chiropractic. WHY? Well, we have the research to show what happens when an adjustment to the spine is performed, so we know there's a physiological effect that occurs, same as in osteopathy……besides, the placebo effect is based upon the power of suggestion. Since we can't "suggest" a healing response to infants, young children, and animals (yes, vet chiro!), how can you rationalize a placebo? Yet they respond to care as well. And another thing, when I have a patient who comes into my office with 20+ years of spine pain/radiculopathy/headache, etc and they've seen practically every other doctor out there for relief, with no results, but respond beautifully to my adjustments,can you really claim placebo? If that was the case, common sense would tell you they would've been healed years ago……but I digress…..

    How we doing so far? Any problems yet? Sounds pretty rational, huh? Let's keep going….Part two next….

  162. 5) The whole natural/alternative thing….yeah,this is a fun one. Am I "alternative"? No, I'd say we are pretty mainstream here across the pond given the number of people who utilize it (approx. 40M people last year alone). I cringe when I hear about "alternative" medicine. What BS. It's just a way that the allopathic community can pigeonhole us. However, I do promote natural, non-toxic living as a way to maintain wellness. What's so bad about that? Our society is rampant with pharma drugs, pollution, additives, artificial ingredients….how the hell can anyone not think this is having a detrimental effect on our collective health? Chiropractors have championed natural healing because it fits well into the philosophy of chiropractic, that is, allowing the body to maintain its health thru non-interference.

    6) One problem we are facing here in America is the assumption that if something is not researched and shows a positive outcome, then it cannot be of any use. How false. It's hard to do a double-blind study on something if you aren't even sure where to start, or what to study in the first place. Sound funny? Yeah, I know….but the whole idea that "that which cannot be quantified cannot be qualified" argument is bunk! We KNOW chiropractic works!…we simply haven't caught up with the research yet! Granted, there's a lot more research produced now than ever before….it just happens slowly. Takes time….as in A LOT!! Our profession has been around for 115 years here, but meaningful research has only been taking place for about 30 years. Look how long it took MD's to figure out aspirin! I wish we had MORE research already done, but when our National Health Institutes budget for chiropractic research is <5% of their total budget (guess where the rest goes!), the research happens very slowly. Besides, let's be honest….if something obviously works, but you can't necessarily explain why it works, does that mean it's not effective and/or useful?? Hmmmm…….

    My apologies, that was a long one………As well, I'm sorry I can't reference specific studies in this post, but I don't have them at hand and it would take too long to look them up……carry on!

    7) Back to research for a second……..please lookup "H-reflex", "anatomical piezo-electric effect", "mechanoreceptor facilitation", "axonal motion studies"…..that should give you a start.

    GO to Part 3

  163. 8) Safety issues. This one really gets me upset. There is NO comparison for risk-benefit ratios to the allopathic doctors. Many properly prescribed medications KILL people, but no one complains. Yet people go crazy about the minute risks with manipulation. Are there risks to being adjusted? SURE! Oh, let's see…..there's sprains, strains, occasional rib fractures, bruising, dislocations (odd, I know), etc etc….but these are all extremely rare and non-life-threatening. And patients here are told about this before we start any therapy regimen. Oh, about strokes?? Don't even start with me here. The whole ridiculous argument about strokes was created by a group of neurosurgeons in Canada with an axe to grind. Can neck manipulations CAUSE a stroke? NO! I don't believe so. (oh, and there's no research to legitimately prove it can, btw) BUT! Yes, manipulations can speed up the inevitable onset of stroke given the prior conditional requirements. In other words, if a patient was going to have a stroke, they would've eventually either way, but the adjustment may have been the final straw, so to speak. However, the incidence of this is so extremely rare, it's almost hardly worthwhile to bring it up (don't worry, I still do). Is 1 in 500,000….1 in 1,000,000….1 in 10,000,000, whatever study you wish to quote….is that worth denying millions of people the benefit of normal, safe adjustments that bring relief?? Who's standard are we using here??? The MD's??? Not hardly!!!

    Oh well, you get the picture. But this is enough for now, I've been on here long enough.

    BTW, yes, I think the whole libel case is bullshit, too! (Pretty screwy libel laws, I might add) I haven't read the book, and probably won't, but the BCA should be strong enough to handle this with public debate, not conniving underhanded measures. And the McTimoney response is embarrassing to say the least.

    To the DC's in Britain, I say "Grab yer nuts and hold on, fellers! It's gonna be a long rodeo!" To the rest of you here, I say- Stop the animosity! No one cares about your bitching anyways. Meaningful, polite academic discourse is better! Keep the political pressure on chiropractic to improve its standards, but cast away the ignorant bias that pervades your media. Thanks for reading.

  164. WOW…..I'm absolutely flabbergasted at the complete lack of real information on here! BackQuacker is the only one actually trying to put forth a reasonable argument in favor of spinal manipulation…and he/she isn't even a chiropractor!!!!

    Here goes….I'm an American (yankee) chiropractor. I practice in Maine with a small, busy office.

    Since there's so much bullshit on here (about 90% of these posts), let me take a small whack at this. Short answers for you Brits….

    1) DC's are REAL doctors. In the US, we take as many course hours of instruction as MD's, and have to pass rigorous national board exams. The gov requires continuing education and practice audits.

    2) The subluxation theory is old and archaic, and I'm sorry you Brits haven't caught on yet. I don't consider spinal misalignments to be the root of all ailments, nor the cure for all diseases. That would suffice as quackery. HOWEVER, I do know that an inflammatory state within the nerve root complex at the spine (think prostaglandins/leukotrienes) causes a subtle loss of axonal transference, which interferes with mechanoreceptor/proprioceptive afferent input to the CNS. Therefore, if you do something (hence, manipulation) to the spine to alleviate the mechanical aberrance creating the inflammatory state, the person gets better.

    Got it so far? Am I going too fast?? Let's keep going….

  165. 3) Chiropractic for children? SURE! They have spines too, don't they? As far as the need for manipulation, if a child gets injured or has mechanically-based musculoskeletal problems, then common sense would tell you chiro can help them too, just as it does for adults. As for ear infections, colic, asthma, enuresis (bedwetting), etc……well, it depends on the child. Some respond well, some do not. Clinical evidence shows a great satisfactory rate for these things, just ask any DC. There is some research to show that chiro helps with these ailments (look up JMPT, JACA, or SPINE journal), but admittedly we need far more to calm the naysayers.

    4) Placebo effect? Oh, c'mon…….while the placebo effect can actually have a legitimate place within healthcare, it doesn't explain chiropractic. WHY? Well, we have the research to show what happens when an adjustment to the spine is performed, so we know there's a physiological effect that occurs, same as in osteopathy……besides, the placebo effect is based upon the power of suggestion. Since we can't "suggest" a healing response to infants, young children, and animals (yes, vet chiro!), how can you rationalize a placebo? Yet they respond to care as well. And another thing, when I have a patient who comes into my office with 20+ years of spine pain/radiculopathy/headache, etc and they've seen practically every other doctor out there for relief, with no results, but respond beautifully to my adjustments,can you really claim placebo? If that was the case, common sense would tell you they would've been healed years ago……but I digress…..

    How we doing so far? Any problems yet? Sounds pretty rational, huh? Let's keep going….

  166. 5) The whole natural/alternative thing….yeah,this is a fun one. Am I "alternative"? No, I'd say we are pretty mainstream here across the pond given the number of people who utilize it (approx. 40M people last year alone). I cringe when I hear about "alternative" medicine. What BS. It's just a way that the allopathic community can pigeonhole us. However, I do promote natural, non-toxic living as a way to maintain wellness. What's so bad about that? Our society is rampant with pharma drugs, pollution, additives, artificial ingredients….how the hell can anyone not think this is having a detrimental effect on our collective health? Chiropractors have championed natural healing because it fits well into the philosophy of chiropractic, that is, allowing the body to maintain its health thru non-interference.

    6) One problem we are facing here in America is the assumption that if something is not researched and shows a positive outcome, then it cannot be of any use. How false. It's hard to do a double-blind study on something if you aren't even sure where to start, or what to study in the first place. Sound funny? Yeah, I know….but the whole idea that "that which cannot be quantified cannot be qualified" argument is bunk! We KNOW chiropractic works!…we simply haven't caught up with the research yet! Granted, there's a lot more research produced now than ever before….it just happens slowly. Takes time….as in A LOT!! Our profession has been around for 115 years here, but meaningful research has only been taking place for about 30 years. Look how long it took MD's to figure out aspirin! I wish we had MORE research already done, but when our National Health Institutes budget for chiropractic research is <5% of their total budget (guess where the rest goes!), the research happens very slowly. Besides, let's be honest….if something obviously works, but you can't necessarily explain why it works, does that mean it's not effective and/or useful?? Hmmmm…….

    My apologies, that was a long one………As well, I'm sorry I can't reference specific studies in this post, but I don't have them at hand and it would take too long to look them up……carry on!

  167. 7) Back to research for a second……..please lookup "H-reflex", "anatomical piezo-electric effect", "mechanoreceptor facilitation", "axonal motion studies"…..that should give you a start.

    8) Safety issues. This one really gets me upset. There is NO comparison for risk-benefit ratios to the allopathic doctors. Many properly prescribed medications KILL people, but no one complains. Yet people go crazy about the minute risks with manipulation. Are there risks to being adjusted? SURE! Oh, let's see…..there's sprains, strains, occasional rib fractures, bruising, dislocations (odd, I know), etc etc….but these are all extremely rare and non-life-threatening. And patients here are told about this before we start any therapy regimen. Oh, about strokes?? Don't even start with me here. The whole ridiculous argument about strokes was created by a group of neurosurgeons in Canada with an axe to grind. Can neck manipulations CAUSE a stroke? NO! I don't believe so. (oh, and there's no research to legitimately prove it can, btw) BUT! Yes, manipulations can speed up the inevitable onset of stroke given the prior conditional requirements. In other words, if a patient was going to have a stroke, they would've eventually either way, but the adjustment may have been the final straw, so to speak. However, the incidence of this is so extremely rare, it's almost hardly worthwhile to bring it up (don't worry, I still do). Is 1 in 500,000….1 in 1,000,000….1 in 10,000,000, whatever study you wish to quote….is that worth denying millions of people the benefit of normal, safe adjustments that bring relief?? Who's standard are we using here??? The MD's??? Not hardly!!!

    Oh well, you get the picture. But this is enough for now, I've been on here long enough.

    BTW, yes, I think the whole libel case is bullshit, too! (Pretty screwy libel laws, I might add) I haven't read the book, and probably won't, but the BCA should be strong enough to handle this with public debate, not conniving underhanded measures. And the McTimoney response is embarrassing to say the least.

    To the DC's in Britain, I say "Grab yer nuts and hold on, fellers! It's gonna be a long rodeo!" To the rest of you here, I say- Stop the animosity! No one cares about your bitching anyways. Meaningful, polite academic discourse is better! Keep the political pressure on chiropractic to improve its standards, but cast away the ignorant bias that pervades your media. Thanks for reading.

  168. To get back to the main point, many people here are not saying that chiro never works, just that their claims are over inflated and that they should not be able to sue Simon for stating that.

  169. "The way it works is that your dorsal horn has been sensitised so that, now, when you get back pain, its usually in the same place, this is caused centralisation. Im glad you dont get much back pain anymore, thats great, but you still sound like a chronic pain sufferer. Again, as ive already explained to you, acute pain lasts up to approx 3 months (debatable) and after that is chronic and centralised. The accepted way of avoiding pain becoming chronic is to treat during the acute phase.
    This is the latest, accepted view on acute and chronic pain. "

    and for all therapies, whether conventional or quacky, giving good narrative is part of the treatment.

    The trick is to show whether your own particular modality gives anything more than good narrative. Especially for something like back pain where it may be an effectively permanent, though fluctuating condition, the really tricky thing is that people's perception of their own problem can be manipulated more easily than their spines can be. That is not necessarily a bad thing but no one should fool themselves into thinking their therapeutic modality has specific benefit if it only and solely gives the patient a new perspective that lets them live better with their problem.

    This is where those of us who demand evidence can meet the quacks, if not half-way, at least someway into the intervening gulf- we accept you can give patients a narrative that in turn gives them a sense of power over what may actually be an intractable problem, particularly if the patient has inflated that problem to be a major focus of their life. The trouble is that the quacks have so much of their own lives vested in their personal form of magic that as we approach them making simple and reasonable points it is to be greeted by the sight of them fleeing in the opposite direction clutching their toys to their chests and crying about nasty people were being horrid to them.

  170. UK GP. What an interesting discussion !

    A few observations. 1. Always be skeptical if anybody sounds too sure of anything. Religious fervour doesn't mix with science. 2. Medicine IS a science. Patient centered/wholistic stuff is nice, and sometimes the icing on a good doc's cake but it MUST be secondary to the hard science. 3. There are no good treatments for acute simple backpain. 4. Weak evidence exists in favour of physio, NSAI, maintaining activity. Everything else is essentially wishful thinking. 5. Mostly, a medic's job in simple back pain is to amuse the patient while nature makes him better, which it usually does. 6 Apologies to chronic backpain sufferers (of which there are legion) but there are few proven treatments, other than sympathy.

  171. I have met people who have spent most of their lives in pain through the balls-ups that licensed medical folk have put them through. These same people have had their health and lives restored through visiting a McTimoney chiropractor just once. What’s your problem, Quackhunters? Is your website devoting any space at all to doctors who misdiagnose disorders, whose ignorance increases suffering, who rely on the swindle of prescribing sugar pills? Thought not.

  172. Classic? Yes a classic evasion/response to someone who asks a very simple question of the motivations and focus of a site like Quackwatch. I’m not a chiropractor, as you seem to assume — I’m talking about the people I’ve met who’ve actually gone to chiropractors (McTimoney in this case) and have experienced miraculous (no, Quackwatchers – I don’t mean literallymiraculous) results after the real physical harm done by no-nothing medical professionals. You know, the kind of people you’re not interested in criticising despite their reliance on fraud (prescribing sugar pills to patients you despise and relying on the “placebo effect” is fraud, no?). But don’t talk about that, just talk about the other subject instead. So, what would you actually SAY to these people who have experienced very real healing effects from chiropractors? Anything? Be polite enough to wipe the foam from your mouth if you do so.

  173. I have read this with some interest. I have visited mainly Osteopaths (but other ‘complimentary’ as well) people for around 18 years now. When I originally had a back problem at the age of 24 I was told (by a physio) that I should never play football again and that I should wear a back brace and do swimming once per week. Thankfully I visited an Osteopath who, after a couple of treatments, had me running much more freely and the power to my left leg had returned (which was the original point of the visit). Since my original visit to the Osteo I have had problems with a tight back which was easily sorted out by a visit to an osteo (this seems to be accepted by BSM and Le Canard Noir as something that can be claimed by the ‘quacks’) and a couple of instances of a leg that has become quite powerless and needing to be dragged (once again fixed quite easily during visits to the quacks – not sure if BSM and Le Canard accept this so reaily or not).

    My point is that while I partly agree with BSM and Le Canard that claims about curing colic or whatever through manipulation is a little more ‘fuzzy’ I would ask them to provide unrefutable evidence (since they are claiming it is quackery) to the contrary. They can quite rightly claim that without absolute evidence it is not a claim that can be made. Conversely they cannot, without unrefutable evidence, claim it is quackery. The simple position (taken, I think, a bit more by BSM than the ultimateley I’m-right because-you-can’t-prove-it Le Canard) is that we cannot say one way or the other.

    If BSM and Le Canard want to disregard tons and tons of anecdotal evidence as coincidence (it would be interesting to get statisticians working on that) and say all Chiropractors etc are quacks making false claims then they must surely be happy to dismiss other approaches as quackery. The physiotherpaist I saw was definitely speaking quackery for a start because I showed that she was totally incorrect.

    I am not going to pretend to be a reader of lots of research but I would like to ask them about the double-blind trials they stand so confidently behind then can they please inform me if all of these trials for various things made sure that the people involved were done in sealed units with all germs microbes eradicated from the area, no changes in diet, no changes in washing materials, clothes etc etc to the point that there was ABSOLUTELY nothing to affect these trials. If not then I must conclude that the trials were worthless because they were lucky coincidence.

    Perhaps the better approach would be to accept that there is something in the weight of anecdotal evidence supporting some of what ‘complimentary’ medicine claims even if it does not manage to get backed up through their ‘rigorous science’ they stand behind. It may be that the ‘complimentary’ medicine was a secondary thing that started the real causal effect, it may be that the medicine in question was the causal effect. We just don’t know.

    What I find disturbing is that BSM (who to my mind is the more reasoned person) and the very stupid Le Canard (who seems to wriggle and change direction) seem (possibly) to readily accept trials that may have been conducted by monetarily-interested parties on a few people but totally against lots of people telling them something else.

    I really object to being told that I have been ‘fooled’ by complimenary medicine when it was ‘complimentary’ medicine that has quite obviously helped me and conventional medicine that quite obviously was wrong.

    Perhaps we should look at what scientific research has shown us down the years only to be proven incorrect.

    Can Le Canard and BSM (without resorting to deflecting the question by labelling me as talking quackery) answer the simple question of how they can absolutely prove that Chiropractors etc etc do not cure the things they have claimed. Please remember that I am in agreement that they have a right to claim it. I would just like the irrefutable evidence that they are not correct.

  174. Adrian – what you are attempting to do is to shift the burden of proof. It is not up to me to absolutely disprove every wild claim made by quacks. It is up to them to have the responsibility to provide proof of their own claims. Chiropractors make the claims about colic – it is incumbent on them to provide suitable evidence. You are also attempting to ask for ‘absolute’ proof – something that would make any scientist cringe.

    Quackery is very much the promotion of cures without appropriate evidence. Anecdotes are just that. You are confusing the fact that you feel better now for your explanation of what happened. Just because one event follows another does not mean one event caused another.

  175. I think you will find that I have addressed all your points in my original psting. However, I will answer you as follows:

    1. I am not attempting to shift any burden of proof. I have quite clearly stated that there is no right to make such claims as are being made by chiropractors. In addition to that I have stated that claims made by convential medicine must also be subject to such scrutiny. If any evidence presented by chirprators is to be dismissed as coincidence (as seems to be the case) then without an absolute 100% water tight study, performed in surroundings free of any minute change whatsoever conventional medicine studies can be dismissed as coincidence. You can’t have it one way to suit one argument and anither way to suit another argument.

    2. Asking for absolute proof probably would make any scientist cringe and therein you have the real point to what I say. You or others on here cannot say with ABSOLUTE certainty that chiropractic treatment or whatever is quackery because it might, just might be true. Likewise, chiropractors cannot make claims that cannot be ABSOLUTELY proven because they might not be true.

    3. You speak of evidence. What evidence is that? You may cite me a report that is 95% certainty (I believe that is what is considered to be accepted as scientific is it not). What about the 5% non-certainty. As a hypothetical example what if all the tests done to show that smoking is bad for the body had actually been tarnished because many of the smokers groups had – by coincidence – knocked something on their leg which is a point of the body that triggers lung cancer. As unlikely as it seems you cannot rule out that this coincidence could have occurred and could indeed be the causal effect not the smoking. Did the researchers ensure that everyone was not knocked on the left leg? No I doubt it. Thus you cannot rule things out because you refuse to accept anecdotal evidence (after all surely we just claim that all those smokers would have died anyway) and claim things are true unless you have ABSOLUTE PROOF (which would be impossible to get).

    4. What exactly do you class as anecdotes? I mean conventional medicine told me that if I continued to play football then I would be pretty much crippled by the time I was 30. I played until 34 and still walk about with no problems whatsoever. Is that now aecdotal or a piece of evidence against physiotherapy?

    To sum up where I am coming from. I am happy for people such as Le Canard to be totally suspicious of chiropractors etc. It is his choice. However, if he wants to promote one thing as quackery (which again is his right to do so if he believes it) while simultaneuosly presenting something else (that has not been absoutely proven) then he is no different from engaging in quackery himself.

    The best bet for him and others on here is to follow what they believe for themselves and let others do so without labelling them as ‘fooled’. In my opinion Le Canard and everyone else has been fooled by conventional medical experts and a pharmaceutical industry (that is, monetarily, far bigger than the £40 a time chiropractors he derides as self-interested in money) every time they take medicines. However, I allow him to continue on whatever path he sees fit for himself and wish him all the luck with it. I don’t have to attack him about it.

    Now if this silly debating point of chiropractors having to unequivocally prove their craft then let us have the unequivocal proof that aspirin works.

    My final question would be…if scientific proof is so great then how come so many sound scientific reports conflict with each other? From this it would seem that this sound science you all espouse here is contradictory and not worth the paper it is written on. Perhaps I’ll just stick with the equally unsound anecdotal evidence.

  176. Aspirin has been subjected to seventy-two randomised single-dose trials for pain relief and Cochrane concludes “The results confirm that aspirin provides effective pain relief for acute pain of moderate to severe intensity.”

    http://www2.cochrane.org/reviews/en/ab002067.html

    Nothing in chiropractic has been subject to anything like the same level of scrutiny.

    If you wish to carry on debating these issues, (and you are horribly confused at present) I would suggest you read “Testing Treatments: Better Research for Better Healthcare”

    http://astore.amazon.co.uk/thequack-21/detail/1905177356

    It’s a thoroughly good book, designed for the layperson without requirements of maths and stats. It will answer your questions quite thoroughly – far better than is possible in a debate on a blog.

    • Mmmmm, Andy….I am starting to become suspicious of how you now choose to start cherrypicking your replies. You’re starting to sound a bit like quackery here.

      Firstly we will just discount your ‘scientific’ studies as pure coincidence. After all, you discount the anecdotal evidence of much more than 7,000 people as pure coincindence.

      I see you also become a bit condascending by suggesting that I am horribly confused at present. On the contrary, it is you who are horribly confused. You are so wrapped up in believing that scientific evidence is the absolute be and end all that you cannot see a reasoned argument to the contrary (instead preferring to just continue quoting the scientists I have already commented could possibly – heaven forbid! – be wrong). For instance you refuse to accept the idea that the ‘coincidences’ you believe about anecdotal evidence could not possibly occur in scienctific experiement as well. You refuse to comment on the fact that only around 95% confidence levels are (I think) needed for an experiment to be considered to be scientific (what about the other 5%?). I am making a point on a much larger scale and saying that none of it is something you can absolutely prove so just as much as you call chiropractors etc quackery and anecdotal evidence quackery I call your 7,000 people tests quackery. After all there is quite a vested interest in people believing aspirin does them good, is there not? The testing makes only a brief excursion into the differences between the people (it talks about 40 people suffering something or other and being discounted). Once again I ask you whether these people were subjected to ABSOLUTE equality of conditions or did some knock their knee, go outside/stay inside (nth degree of permutations combinations). If you cannot agree that there was ABSOLUTE EQUALITY of conditions then sorry old son you are open to quackery claims.

      I see you failed to answer what were considered anecdotes. In your aspirin testing how did the researchers know that the pain had improved? The only way you can ascertain that is to ask the person. Surely that is anecdotal? Thus you are now arguing that the anecdotal evidence of 7,000 people is greater than the anecdotal evidence of millions of people. If, however, you tell me that they had some machine to measure the patterns of response etc etc then I must denounce this as quackery unless you can ABSOLUTELY prove that the machine can do what it is supposed to do or that there is definitely no other method of receiving pain that we do not yet know about etc etc. Do you see, Andy? I know you are confused by what I say because I am not trying to come and make an argument on your narrow grounds of proven science as you see it but am actually asking you to now justify why any of the scientific studies that you seem so ready to accept is indeed correct at all. It seems a concept that is too great for you and you will now doubt have to quote me some more studies that I will quite happily dismiss as quackery to sell pills unless they are 100% proven (impossible).

      Please show me how science experiements can get rid of absolutely all permutations and combinations of differences between potential external influences to ensure that there is only the subject matter being tested that changes. I think you will have a hard time doing that.

      Finally, I did ask why, if science is so accurate, do so many scientific experiements and scientists disagree with each other? Quackery?

  177. Hello Andy, Hello Adrian,

    I do see a theme here: Adrian is making perfect sense in an egalitarian, relativistic way. He just seeks to be fair!

    “If chiropractors want to call their procedures ‘medical treatments’, then they better have evidence. And if Andy wants to call someone a quack, then he better have evidence, too.”

    Do you guys see the balance here?* It is tempting, but it is wrong. One problem here may be that the assertion “ABC is a quack, XYZ is quackery” can easily be interpreted as an accusation, and -in dubio pro reo- there we are and must, by all means, satisfy that gut feeling of injustice and provide evidence.

    It may be helpful to be reminded that “quack” is just a handy way of saying “person who claims medical benefits without proof” and, likewise, “quackery” means something along the lines of “unproven ritual with alleged curative effect.”

    Keeping that in mind, it will hopefully be clear why it is not Andy who has to provide evidence that ABC is wrong or that XYZ does not work beyond placebo. This “burden of proof”, as we have already discussed, lies with whoever comes up with the stuff.

    Why is it that people will not accept it if I just claim I’m a pilot or an electrician or a high school teacher**, but that it seems to be alright to claim I can heal people? Oh right, because crashing a plane and burning down the house are pretty drastic signs to indicate I’m wrong, whereas people’s health does get better on its own in oh so many cases…

    Greetings,
    Daniel

    *) Ben Goldacre would probably blame it on “those humanities graduates” – our society has become so politically correct that we feel we must protect people no matter how wrong their beliefs are. We feel that we must give equal attention to somebody who believes the earth is flat and is circled by the sun as to all the mass of evidence that says otherwise. This is the position of alternative medicine: Claim the earth is flat, demand “the elites” to prove it is not, refute all their evidence and style yourselves as suppressed mavericks. Pathetic, but true. And the media are giving them their attention…

    **) As for the high school teacher… That would be interesting – Kids develop, and learn a lot on their own. Quite possibly an incompetent and unqualified self-proclaimed teacher could not do a worse job than a most disinterested actual teacher? But I digress.

  178. Hi Antares

    I don’t disagree with you comments about my argument. I also have no disagreement about saying that chiropractors must prove their claims.

    What I do disagree about is that chiropractors etc shhould have to prove their claims to a science world based on the science world’s principles but the science world is so arrogant it presumes that it seems to believe only it has the right way of doing things and the correct answers.

    The only point at which the science world has the right to denounce others is the point at which it can logcally explain and absolutely prove everything. Until then it hasn’t really shown anything because there could be the chance of coincidence (no matter how small it is there). We both know that this point will never be reached so theoretically we cannot accept anything as true. As such, we accept what we decide to accept what we see/believe for ourselves. Some accept that aspirin works, others do not. Some accept that chiropractors work, others do not.

    If, as I readily accept, that chiroprators claim something then they must prove it. However, those ready to denounce it – beyond saying prove it must also prove that it is otherwise they should just stick to saying prove it (I am talking theoretically not legally here because talking legally puts more constraints on). May I also make the assertion that a quack is an untrained person who dispenses medical advice. If science cannot prove itself to be absolutely correct in just the same way as chiropractors cannot then I would suggest that this mocking site is called ‘Prove it’ rather than ‘Quackwatch’ unless it is prepared to mock the scientists as well.

  179. “The only point at which the science world has the right to denounce others is the point at which it can logcally explain and absolutely prove everything.”

    You are clearly absurd. Philosophically naive in the extreme and (I would guess) self-taught.

    Requiring absolute standards of proof is a ridiculous position to take – as it is obviously not possible. But that does not mean one can talk meaningfully about a hierarchy of evidence and degrees of certainty.

    Life would collapse if we did not. Can you still be sure the shops will still be there before you set out for them? Or will you embark on your journey with mere confidence of success?

    Law courts cannot demand absolute levels of proof. They ask for balances of probabilities and evidence beyond reasonable doubt. . Mistakes will be made, but can we not be confidence that justice is done more often that not? Can we not ask scientists to tell us what the evidence suggests and their level of confidence in the result?

  180. Le Canard Noir said it quite well. The outrage by “quackbusters” is absurd. I find it unbelievable how people think allopathic medicine is “proven” and chiropractic care or any form of natural health care is a joke. Needless to say “quackbusters are the most ignorant group of bloggers on the web.

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