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A cautionary note about calls to crack down on chiropractic

A few weeks ago, Health Minister Nicola Roxon received a submission calling on the Government to close a chiropractic paediatric clinic run by RMIT University in Melbourne, and raising concerns about the use of chiropractic in babies and children.

The submission was from Loretta Marron, a regular contributor to Crikey/Croakey, cancer survivor and a former Australian Skeptic of the Year who advocates against unproven and disproven alternative therapies.

As I reported in the BMJ at the time, the science writer Simon Singh and the complementary medicines expert Professor Edzard Enrst have lent their weight to Marron’s campaign, as have several prominent Australian medical and scientific experts.

However, another Croakey contributor, Jon Wardle, argues below that there are many benefits to keeping chiropractic training within the university sector. Rather than tarring the entire field with one brush, critics would do better to pursue the minority who are charlatans, he says.

***

Will taking chiropractic training out of universities really protect patients?

Jon Wardle writes:

Recently a submission to the health minister recommending the closure has made news both nationally and internationally in an effort to force RMIT University to close down its paediatric chiropractic training clinic.

Although the submission initially suggests it is a request to only close down the paediatric clinic at RMIT University, as it promotes the use of unproven and harmful remedies targeting pregnant women and children, it goes further to suggest removal of chiropractic training from the university sector altogether.

The submission says “[i]t is high time that universities returned to their core principles and dropped pseudoscientific courses which lead to attacks on vaccination and the promotion of expensive, useless and potentially harmful treatments”.

In addition to RMIT University, the submission also suggests courses at Macquarie University and Murdoch University should also be investigated.

But would removing these courses and clinics from the university sector really be in the public interest?

A university chiropractic course is comprehensive, usually lasting five years. The RMIT course has twice the amount of conventional anatomy, physiology and health sciences units as it does units specific to chiropractic practice.

But even the chiropractic units have a substantial conventional health science element to them as well.

That’s a lot of ‘real’ science for what the submission calls a ‘pseudoscientific’ course. Students are even taught clinical research skills to evaluate evidence.

The reason for this is because although chiropractors may have their own philosophy on healing, they must also work within the conventional health model.

This high level of conventional training also means that practitioners can recognise the limitations of their therapies, be made aware of serious conditions that require referral, can recognise ‘red flag’ situations, and of course can also better assess treatment risk – and therefore minimise these risks – when delivering their treatments.

What’s more, this increase in standards has been a direct result of moving chiropractic training into the university sector. In fact the federal government’s 1977 Webb report recommended regulation of the profession and inclusion in the university sector specifically to increase these standards.

This is important because the simple fact is Australian’s have a right to choose their health provider as they wish. To deny patients this right would be construed as anti-competitive.

The fact is one in six Australians do choose a chiropractor – and they will continue to see them regardless of where their clinical training comes from.

Having this training in a university setting rather than the private sector (or from within the profession itself) provides for better and safer practitioners.

Whilst the evidence base for chiropractic in children is low, this does not necessarily mean that such treatments should be automatically denied.

Some children may respond well to chiropractic – whether it is due to specific or non-specific effects.

Some of these may be children who have not responded to more ‘evidence-based’ medicine (which, after all, does not actually work for everyone). Where should these children go then?

And of course whilst the submission primarily made reference to the inappropriateness of chiropractors treating non-musculoskeletal conditions in these populations, some children will require musculo-skeletal treatment, though admittedly the evidence for this area is also lacking (for both positive and negative trials).

Even if the practitioner does refer, it may be their duty of care to provide an attempted treatment within the initial consultation if it does not pose undue risk. To do nothing may simply not be appropriate. After all, it could be weeks before the referral appointment can be made.

Although it shouldn’t be first-line treatment, there is a case for chiropractic to at least be another option for child treatment.

Chiropractic has come a long way since the days of ‘vertebral subluxation’ being seen as the only source of illness. Not every modern chiropractic treatment focuses on manipulation.

Chiropractors learn far more gross anatomy and as much physiology as most health professions. Most chiropractors work in conjunction with other health professions, and often expand their treatments to include massage, physical therapy, dietary and lifestyle advice and some medicines.

They generally focus on musculoskeletal conditions, though like any other health profession in Australia are not limited to these conditions.

Nor is spinal manipulation a therapy that is limited to chiropractors. It is also taught to and practised by osteopaths, Chinese medicine practitioners, ‘musculo-skeletal therapists’ and naturopaths on the complementary side of the practitioner fence, and physiotherapists and medical practitioners on the other conventional side (the venerable Professor John Murtagh has even written a book on the topic).

Patients will continue to utilise these services. The most important thing is that chiropractors are made aware of their limitations and refer when appropriate. University training clinics are the ideal places to learn such skills.

However, RMIT does have a duty to explore evidence in this area – it certainly goes without saying that RMIT University really should get its act together in developing a research program at its chiropractic school. Though it also goes without saying that this has been a problem in clinical training courses across the professions.

This professional division exists between chiropractic ‘purists’ who believe that all disease is sourced in the spine, and those who are more integrative in outlook. ‘Purists’ are now well in the minority – though it is admittedly a vocal one – and their numbers have been diminishing further as chiropractic training has moved into universities.

Taking training out of the university sector will only support this fringe group, not stop it.

In is arguments the submission focuses on this ‘old’ chiropractic, suggesting that ‘chiropractors say’ that 80% of all health problems are caused by spinal problems. Whilst this is true for a segment of the chiropractic professions, chiropractic internationally is bitterly divided, and this isn’t a representative view of the whole profession.

Additionally, concerns about the impact of chiropractic on public health measures such as vaccination aren’t necessarily supported by the evidence in this area.

It is true that some chiropractors do advise against vaccination, but most chiropractors don’t. Canadian studies have even found that two-thirds of chiropractors have vaccinated their own children, though no data exists for Australian chiropractors (though it should be noted that the Canadian profession is in fact less ‘mainstream’ than the Australian one).

It is also true that international studies also show that children who see a chiropractor are less likely to receive full immunisation. And they show this pretty consistently.

However, implying that such data means that chiropractors are automatically advising patients not to use vaccines amounts to classic attribution error – mixing causality with correlation.

Other factors are at least equally as likely. For example, families who see chiropractors are probably less likely to vaccinate anyway, as parents with an alternative medicine orientation’ are more likely to reject vaccination – regardless of what their healthcare provider says.

This error also informs the submission’s focus on the Australian Vaccination Network – a group that is not run by health professionals of any persuasion. The 120 chiropractic members of this organisation, who the submission focuses on, equates to less than 3% of Australia’s 4387 nationally registered chiropractors, and are most likely from the fringe of the profession.

Rejection of vaccination amongst chiropractors usually relates to original chiropractic philosophy, which saw all disease linked to the spine and vaccines interfering with healing. Such outdated views are disappearing, and are the minority of the profession.

In fact, by having courses in the university sector, students are exposed to positive information on public health measures such as vaccination. In fact, international studies demonstrate that anti-vaccination rates of CAM practitioners are directly related to conventional health science levels in courses, and that most anti-vaccination ‘education’ in chiropractic comes from outside the formal training sector.

There are clear risks to therapies used by chiropractic – particularly spinal manipulation. This is why the profession is regulated and minimum standards of training are imposed. In fact Chiropractic Boards in Australia receive far more complaints about spinal manipulation by unregistered practitioners than do about chiropractors.

There are other risks as well – notably financial exploitations through over-servicing. However, this does constitute a breach under the national registration scheme legislation (as does misleading advertising), and regulatory arrangements are in place to discipline such practitioners.

There are undeniably a lot of charlatans in the field, and the submission is right to criticise them. However, the 50 New South Wales practitioner websites she uses to illustrate what ‘chiropractors say’ represent well under 5% of practitioners in that state.

Tarring the whole profession with the same brush as its ‘lowest level’ does little to recognise the complexities and breadth that exist in the profession. The issue is one that is grey, not black and white. Failing to view the world as such is dogmatic and, dare I say, quite unscientific (and skeptics really should know better).

Additionally, to say that RMIT is responsible for the actions of students once they graduate draws an incredibly long bow. Universities simply aren’t in control of their alumni once they graduate.

For the same reason St Mary’s Hospital Medical School (now Imperial College Medical School) shouldn’t be punished for the claims of Andrew Wakefield – which have done far more damage to vaccination rates than a few rogue chiropractors.

If the authors of such submissions are truly interested in public safety rather than initiating a crusade against a specific health profession, their time would be better spent highlighting the actions of specific practitioners to the appropriate regulatory authorities.

Such mechanisms and safeguards already exist, not only in practitioner regulatory arrangements but also other pieces of legislation, such as that enacted by the Australian Competition and Consumer Commission against misleading allergy treatment claims.

With Australia having one of the highest public levels of support for complementary and alternative therapies in the developed world, it would be a very brave minister or vice-Chancellor that closed down an established course with no real benefit to the public for doing so.

However, taking away the very thing that has progressed chiropractic beyond outdated philosophy to a modern health profession could have serious ramifications for the public.

• Mr Jon Wardle is a naturopath, complementary medicines researcher at the University of Queensland School of Population Health, and a director of the Network of Researchers in the Public Health of Complementary and Alternative Medicine

Comments 28

  1. rachaeldunlop says:

    I think John makes some valid points and I too would like to see the figures for how many chiros subscribe to pseudoscientific beliefs. It doesn’t matter how many years of education you get if it’s the wrong type of education and John’s point about “it’s better to be in unis than not” is moot if students are still being taught there are imaginery subluxations. If as he says there is so much science in these courses, then why even bother calling it chiropractic – just make it physiotherapy which is the same without the unscientific bits. It seems to me that chiros could contribute to health care if they lost the anti-vaccination, anti-germ theory, we-can-cure-anything-with-chiro stuff, but then aren’t they essentially not chiros anymore? They are physios?

    I read with interest COCAs comments on the new code of conduct and they were unequivocal in their statements that there should be more legislation preventing chiros from giving any advice about vaccinations – unless they are suitably qualified. But chiros do – Nimrod Weiner gives free 2 hour seminars about it every few months – and a cursory glance at Google shows he is not alone is his ideas on this issue. John says there are a small percentage who work outside their area of expertise but it is not difficult to find those who will claim to treat ADHD, asthma, even a clinic which claimed chiro increases your kids IQ. Where’s the evidence for that? Sure there are mainstream clinicians who are also anti-vax and use say homeopathy (no evidence for efficacy) and acupuncture (scant evidence for efficacy) and these are also the subject of criticism. But I don’t see many MBBS saying they can increase your IQ by cracking your back.

    I’m interested to know what exactly constitutes pediatric chiropractic qualifications – John defends access for children – but what do they learn that other chiros don’t?

    The big picture here is that pseudoscience should not be taught in universities. And chiropractic is not the only culprit in this regard.

    • Bill says:

      A naturopath commenting on a DC? (Or vice versa) Lol
      That is hilarious on every level.

  2. Tim Mendham says:

    I agree that “Australians have a right to choose their health provider as they wish”, but likewise they should be informed of the issues with any such provider, especially if the service being offered is suspect, and particularly so if it is being offered to children. John Wardle himself says “the evidence base for chiropractic in children is low”, so why practice it until the evidence base is higher? Children’s safety is paramount in any treatment, medical or otherwise. But children are specifically targeted by chiropractors. The promotion for a current series of smeinars, put on by a Dr Glenn Maginness, on chiropractic services for children offers such incentives as: “How to create the ‘It’s normal for children to be adjusted’ mindset with your clinic and your community”, “How to have the majority of your patients as children” and “How to convert your local MD into a ‘general referrer’ of chiropractic patients (both adults and children).”
    Inclusion of any subject in a university calendar gives that subject cudos derived from the imprimatur of a distinguished seat of learning. One would like to assume that that seat of learning’s reputation is not based on suspect activities. So while it’s true that “Universities simply aren’t in control of their alumni once they graduate”, perhaps RMIT should look to its own staff. RMIT Associate Professor Phillip Ebrall, Discipline Head (Chiropractic) “responsible to the Head of the School of Health Sciences for all matters pertaining to chiropractic as a discipline of RMIT University”, seems to be a supporter of astrology. “I am proudly Aries” he says on his blogsite (http://www.ebrall.com/ebrall.com/who_am_I.html). Prof Ebrall is also a member of the Management Committee of the Australasian College of Chiropractors. By any measure, astrology is not a science, and astrology and universities do not and should not mix. When anyone holds such unscientific beliefs, it raises an eyebrow, at least. But Prof Ebrall is not just anyone; he holds a senior academic position within RMIT’s chiropractic activities. One would hope that he does not apply the same non-scientific approach to the evidence for chiropractic as he apparently does to astrology. Running clinics based on practices that are low on evidence should not be an area to which universities give their stamp of approval.

  3. Jon Wardle says:

    Hi Rachael,

    I wouldn’t say that chiros who practice more conventionally are just physios. There is a definite professional culture (which actually goes far beyond subluxations, though this is where most people focus) that differentiates them from physios. This is like saying that massage therapists are the same as physios. Similar, yes. Same, no. It’s the same reason nurses and midwives are separate professions; or psychologists, counsellors and psychiatrists. The list goes on.

    The problem is that you don’t hear a peep from the majority of chiropractors who work in the background in private practice not making ludicrous claims or holding free anti-vaccination seminars, and therefore the fringe are the ones that automatically have a higher profile. However, anecdotal reports of the minority that are flouting conventions shouldn’t be seen as ‘representative’ of an entire profession.

    It should also be remembered that most professions don’t have ‘paediatric-specific’ qualifications to see children. But if a profession does see children post-graduation, I would like to see that they’ve at least had some experience in their training. I would suggest not having specialist qualifications doesn’t stop you seeing children in practice, but I would agree that you shouldn’t claim to be a specialist in this area unless you’ve got them.

    Most chiros would support germ-theory, do know their limitations and work with the conventional sector (most in fact focus on MSK) etc. And I do in fact know of a number of MBBS graduates making equally ludicrous claims – some of the quackiest quacks I’ve seen are actually MBBS. Yet for some reason people on the fringe in that profession are seen as the exception, but people on the fringe in chiro are seen as being the rule. They’re both fringe and should be targeted accordingly.

  4. Rorschach says:

    Melissa, if you are concerned about “tarring the entire field with one brush”, maybe you should look at the website of the Chiropractic Association of Australia, and read up on what flawed concept these people base their field. I quoted it in an article I wrote about our new Victorian Health Minister, a chiropractic, here :

    How Does Chiropractic Work?
    Chiropractic is based upon the understanding that good health depends, in part, upon a normally functioning nervous system.
    Chiropractic works by helping to restore your own inborn ability to be healthy. When under the proper control of your nervous system, all the cells, tissue, and organs of your body are designed to function well and resist disease and ill health. The chiropractic approach to better health is to locate and help reduce interferences to your natural state of being healthy.
    A common interference to the nervous system is the twenty four moving bones of the spinal column. A loss of normal motion or position of these bones can irritate or impair the function of the nervous system. This can disrupt the transmission of controlling nerve impulses.
    Chiropractors aim to improve nervous system function primarily through chiropractic adjustments (with particular attention to the spine, skull and pelvis), to help remove any interference that may be impairing normal health.

    This is a flawed, incorrect premise that does not correspond to scientific or medical realities. Which part of this is unclear to you ? It’s pseudoscience, and should not be taught at universities. Or anywhere, for that matter.

  5. Rorschach says:

    Actually, this post has upset me sufficiently to write my own response to Jon Wardle

  6. jimmila555 says:

    Of course it is psuedoscience ! The anatomical/physiological assumptions that “Chiropractic Medicine” expounds is patent ignorant nonsense, and the conduct of the “Chiropractic Profession” is, and has always been completely shameful.
    The only redeeming factor of Chiropractic is that it is an excellent business model.
    It should be dragged with the derision it has earned out of the “medical school” and given pride of place in any “business school”.
    It’s access to medicare rebate (under the ‘formerly-known-as EPC’ scheme) should be recinded without question, if “evidence-based-practice” means anything.

  7. Owlish says:

    Acupuncture was once considered unscientific. I have a number of medical practitioners in my family (a surgeon, a nurse, two GPs and a physiotherapist) and they are very conservative. They were very anti alternative treatments, however one member of the family had a great response to acupuncture for Bell’s Palsy and now another is trained in acupuncture. This has lead to use of other “alternative medicine” approaches, including chiropractic.

    I’ve been to chiropractic and had relief from an issue that conventional western medicine did not help at all. I have never once been advised not to vaccinate. I’m surprised that the two are linked in any way. My practitioner was trained at Macquarie University and was very professional. The advice he gave me has since been reinforced by two physiotherapists however his treatment approach was very different to physio and resolved my back issue completely.

    I have been to another chiropractor when I was away in another city and had a neck issue. This person was unprofessional and I was very concerned about his lack of professional boundaries, although not about the treatment I received. I only went for one session and it did help (however due to his lack of professionalism I would never go back to him!)

    There will always be good and bad practitioners (just as there are good and bad doctors). I agree that it’s important to keep chiropractic within the University system, research chiropractic approaches and keep high standards in the industry.

  8. Mick Vagg says:

    I think Jon is being altogether disingenuous about the ‘noisy minority’ Argument. A quick perusal of the website of the notorious Australian Vaccination Network (www.avn.org.au) reveals that the current President of the CAA and most of the executives of several State branches of CAA are fully paid-up supporters of this completely anti-science organization. These are not fringe practitioners, Jon, these are the leaders of the organized chiropractic profession.

    With regard to your argument from populism, it is as unconvincing as ever. Surveys consistently show three quarters of Australian believe in the paranormal, but we do not see university departments of Ectoplasm Studies or Alien Cultural Studies. Popularity does not equal being right in science.

    My final comment would be that you appear to be completely wrong about belief in the subluxation dying out. Just last year RMIT released a Position Statement on the Vertebral Subluxation Complex as an official document for their discipline. It makes for mystifying reading given what you are claiming about chiropractors being trained to be science-based.

  9. Mick Vagg says:

    And with regard to evidence base for paediatric chiropractics, it’s not ‘low’ it’s ‘non-existent’ as the existing studies , such as they are, are actually unsupportive of chiropractic intervention. It is up to the proponents of a treatment to convince their peers using evidence that treatments should be introduced. It is not up to clinicians to give unfounded ‘therapies’ a free pass while they try to scrape up some science to support them. That is not picking on chiropractic. In science-based healthcare it’s how we roll.

  10. Shooba says:

    I think simply denying them the ability to use the words “doctor”, “clinic” or “practice” would go a long way.

    Your average Australian simply assumes chiropractic is medically sound. If they visited their local “chiro centre” to be treated by plain old “Steve Ward” with a diploma on the wall instead of “Dr Ward” and his degree I think that would make people do research for themselves, and then hopefully cancel their next appointment.

  11. Doctor Whom says:

    Nor is spinal manipulation a therapy that is limited to chiropractors. It is also taught to and practised by osteopaths, Chinese medicine practitioners, ‘musculo-skeletal therapists’ and naturopaths on the complementary side of the practitioner fence, and physiotherapists and medical practitioners

    This is one of the funniest statements I have seen for a long time.

    ” A whole lot of other psuedo scientific quacks makes these claims too so why pick on chiros”

    RMIT also teaches Degrees in Acupuncture, Herbal Chinese medicine and wellness etc etc. I doubt they will get too excited about the unscientific nature of chiropractors.

    Get this from the course on WELLNESS:

    This fully online course is designed to provide an overview of the diverse field of energy medicine including its historical and theoretical basis, diagnostic and therapeutic models and applications, and the scope of its current research and evidence base.

    Energy Medicine is on the frontiers of science and technology where ancient and modern knowledge intersect. An emerging field, it provides foundational science and theory for a range of different diagnostic and therapeutic practices in both conventional and complementary medicine. To explore ‘Energy Medicine’ one must utilises scientific exploration carried out across a multifaceted scientific bandwidth including detailed work from the fields of Mathematics, Biology, Chemistry, Psychology and Physics and Quantum Physics. Study in this field requires a truly holistic scientific exploration where laws of nature are integrated at a deeply fundamental level. Patterns of effect are so fundamentally entwined with the mathematics of creation and consciousness that at the deepest level, they seem to operate under hence unknown principles governing quantum mechanics and non local Universe principles.

    I look forward to the Tarot course and the subsequent registration of Astrologers and Tarot readers.

    Jon Wardle I’d be keen to see what research the University of Queensland School of Population Health is doing on the “science” of naturopaths and complementary medicines. Any published research papers would be welcome.

  12. David Roberts says:

    Went to see a chiropractor for a neck problem – after fixing that, a 3-month course of treatment to correct my spine cured my asthma (which I’d had for 38 years) involving no drugs or side effects. Lets talk about the most profitable business model – the lifetime use of drugs prescribed by doctors. PBS anyone?
    It’s been two years now. I don’t have to spend the rest of my life on expensive asthma medications. Wish I had been to chiropractor as a child and had my spine properly corrected. The chiropractor never promised to cure my asthma, and I hadn’t expected it. Incidentally, he believed in all sorts of alternative medicine, some which was interesting to say the least. Who cares, I’m overjoyed with the results.

  13. johnd says:

    “a 3-month course of treatment to correct my spine cured my asthma”

    I’m glad your asthma has been cured, but it had nothing to do with the spine-flexing provided by the quack. It just happened to occur at the (roughly) same time. Unless you or the spine-flexer can provide some cause-and-effect evidence, then I’m afraid you have to put this down to coincidence.

    …or the placebo effect.

  14. Rob Loblay says:

    “…a 3-month course of treatment to correct my spine cured my asthma”

    A truly miraculous result (i.e. without scientific explanation) – however it would have been even cheaper to buy a bottle of Lourdes Water which can be ordered over the internet for $14.95. Thousands of satisfied sufferers who have been cured from dozens of incurable diseases can’t possibly be wrong!

  15. SoulmanZ says:

    owlish, you say “acupuncture used to be considered unscientific” as if that is a good reason to allow something “unscientific” to be practiced

    ignoring that gaping logical flaw, to address your line itself – acupuncture is still considered unscientific

    as in, there is no evidence that it works better ‘than sham’. That is a key point. Acupuncture does have an effect. The effect is sticking needles into the skin. But no study has ever shown to any reasonable level that an acupuncturist gets better results than you would get rolling around on needles

    you could liken it to someone performing a surgical procedure on you that is no better than you cutting yourself open and taking something out at random. Obviously acupuncture is a bit less risky, but you wouldnt say the surgeon is ‘scientific’ would you?

    all CAM stuff is fine (if it is not harmful). It helps people, so it is ok. The problems come when people claim things that are not supported, or hide things that are supported, and in CAM, including chiropractic, that is very, very often

    I havent been to a chiropracter in years, but I strongly doubt it has changed to the extent that a chiropracter tells every patient they treat that there is a significant chance of stroke (probably several times higher than baseline) with a simple neck manipulation. This is the problem, if you want to act as a health practitioner you must follow the same rules

    If anyone can refute that, ie that chiropracters now consent patients for neck manipulation, I would be very happy to stand corrected.

  16. Greenmorpher says:

    Let me state at the beginning that back in the 1980s/90s, I did some PR for chiropractic at RMIT and Phillip Institute of Technology (PIT) before it, and for the Chiropractic Association. I also have some biology and other science background.

    So much for disclaimers.

    I regard some of the theory of chiropractic with a skeptical eye, but I certainly am a believer in its efficacy in the treatment of back and neck problems and resultant arm and leg problems. I have had personal experience with this, seen virtually miraculous transformation of a number of patients’ functionality and lives, and had access to carefully, fully scientifically conducted chiropractic research at RMIT that demonstrated the superiority of chiropractic treatment for ordinary back injury in the work or domestic situation over standard medical intervention (with or without physio) at the time. My observation was that medico/physio treatment shifted significantly in the two or three years after those results were made public — but never overtly acknowledging to the results, of course!

    My personal experience is that the best chiropractors combine skeletal manipulation with soft tissue work, freely acknowledging that the two go hand in hand. They also don’t push the notion that you need treatment every week or month forever, but when you do need treatment you need several visits until whatever was not working has settled down to its new working mode. Think of it this way — an adjustment involves some movement of the joints and muscles which were not working in a good way. They had started working in a poor way and you developed “muscle memory” that kept it working that way. The chiro (or masseur, or osteopath, or physio) moves stuff around so it can work in a different, better way. But to complete the process and to keep it all running right, you have to develop muscle memory of working in that better way. Hence a number of treatments to keep the righting right while the muscle memory develops.

    I’ve also had family experience of acupuncture. During pregnancy, my wife developed an agonizing and disabling neuralgia in one leg. Happens moderately often in pregnancy and in fat people. A touch, even by clothing, was like a burn. We climbed the medical ladder until one day we found ourselves in a neurological surgeon’s room with the prospect of an operation under full anesthesia to cut main nerves. What? You’ve told us that this is essentially a temporary condition and you want to apply a potentially permanently disabling “treatment” which only works about 50% of the time anyway, which carries a 1% risk of some disgusting infection as a result of being opened up in a hospital? And hang all this trauma on a 5 months old foetus as well? Not before we try every alternative!!!

    Incidentally, the surgeon’s medical theory — his explanation and justification for what he was going to do — was exactly the same as the first level of theory of chiropractors for their treatment. Only in my experience, chiropractic works more often and never involves infection!

    My wife didn’t trust chiropractic at the time, but was willing to give acupuncture a go. A few minutes acupuncture lessened the pain by about 80%; a handful of subsequent treatments brought it down even further so that it was bearable without support from the occasional (really occasional) panadol.

    Yes, there are what I regard as wild-eyed fundamentalists in chiropractic and like all fundies, they try to control the world and who subscribe to all kinds of bizarre theories. There are also some practitioners who aren’t as skilled as some other practitioners. The same is true in the medical profession.

    But let’s not get too condemnatory. The medical profession has been less than careful in what it does and how it does it. The old truism that doctors bury their mistakes remains true today; but now you can add to that the pharmaceutical industry. There is very nasty stuff goes on. And as for the scientific basis of a lot of what happens — well, let’s just say with big pharma out their, there are billions of dollars tied up in individual drugs and the patent monopolies of owning them. If anyone hasn’t noticed what has happened to the science on fr too many occasions, then they aren’t paying attention.

    Go to your GP with the flu. What’ll s/he do? Give you a bunch of antibiotics. It’s got nothing to do with the flu — that’s a virus not affected by the antibiotics. You’ll fight that off yourself with something like aspirin and/or dedicated cold and flu medication to control the fever and pain in the interim. No — the taking of the antibiotics will give you comfort (which contributes, like sugar pills, to your peace of mind which then helps you ramp up your immune system to fight the virus) and they’ll protect you in case of “secondary” bacterial infection.

    Downside — they’ll also upset your stomach by killing off friendly bacteria in your gut, feed big pharma, and most troubling of all, contribute just that little bit more to the ultimate, awful result — the loss of efficacy of that particular antibiotic.

    But hey, I’m feeling better TODAY, so who gives a damn about kids dying of disgusting infections 20 years down the track because the antibiotics don’t work any longer?

  17. Mia says:

    On the subject of ‘traditional’, ‘western’ and ‘science-based’ medicine, a few highlights:

    only 1% of the articles in medical journals are scientifically sound
    According to the editor of the British Medical Journal, Richard Smith, only about 15% of medical interventions are supported by solid scientific evidence.

    According to Professor David Eddy, of Duke University, only 1% of the articles in medical journals are scientifically sound and many treatments have never been assessed at all.

    The British Medical Journal (BMJ) website Clinical Evidence reports that, of the 2404 treatments they have surveyed, only 15% are rated as beneficial, while 47% are of unknown effectiveness.
    Where is the wisdom…? The Poverty of Medical Evidence
    By RICHARD SMITH, Editor of BMJ

    British Medical Journal 1991 (Oct 5); 303: 798–799

    MEDICINE-related deaths are killing more people than heart attacks or cancer
    About half a million Australians experience an adverse effect from their prescription medication every year, says pharmacist Ken Lee, whose study “How Safe is Your Prescription?” was launched at the Australian Pharmacy Professional Conference. His research shows about 190 000 hospital admissions a year are associated with medicines and their harmful side effects.

    http://www.theaustralian.com.au/news/nation/medications-kill-more-than-cancer-or-heart-attacks/story-e6frg6nf-1226022801971

    Flu vaccine to be thrown out
    http://www.smh.com.au/lifestyle/lifematters/flu-vaccine-to-be-thrown-out-20101218-191c2.html

    dvertised drugs were supported by evidence that was neither “of reasonable quality, nor independent”
    Prof Brown is from the Department of Emergency Medicine at Royal Brisbane and Women’s Hospital, and the School of Medicine at the University of Queensland.

    They said the ban followed discussions with fellow emergency medicine specialists, who had aired concerns such as:

    – Advertised drugs were supported by evidence that was neither “of reasonable quality, nor independent”.

    – There were cases of “dubious and unethical” research practices by the industry, including “ghost authorship” where scientific papers do not disclose all of their authors.

    – Academics could also face industry pressure to withhold negative research, and together this could “inflate views of the efficacy” of heavily promoted drugs.

    The professors also said drug ads were counter to a medical journal’s mission to provide objective data that enabled doctors to make judgments based on the best available evidence.

    “Meanwhile doctors – and indeed journal editors – generally deny they are influenced (by the ads), yet clearly they are,” they said.

    http://news.smh.com.au/breaking-news-national/medical-journal-bans-drug-company-ads-20110203-1aev8.html

    “The new-found experts developed therapeutic empires with a vigorous entrepreneurial spirit that was undeterred by the ineffectiveness of their treatment methods.” (Bell DS, 1989)
    Med J Aust 151 : 280-284

    …and so on.

    “Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding.”
    http://www.pfizer.no/templates/Page____886.aspx

  18. healthbandwidth says:

    Let’s be frank, evidence is about what happens at the coal face. The use of validated outcome measures in determining efficacy is critical. Selling an upfront ‘package’ of treatments regardless of whether the patient is demonstrating substantive improvement raises questions for anyone interested in health efficacy – university trained or otherwise.

    The key to weeding out the voodoo from effective practice is informing consumers around how to measure medium term practitioner performance as apposed to short term analgesic effects of manipulation.

  19. chirofuture says:

    @ soulmanz- I am a final year Masters of Chiropractic Student. I am just writing to inform you that yes we do indeed inform our patients of the very low risk that a stroke may be associated with a Cervical Spine adjustment. However the same movement that is supposed to precipitate a Vertebral Artery Dissection is probably performed by each and every Australian adult on a daily basis when reversing a car, turning to cross the road, rinsing the water off in the shower, going for a swim etc.

    The 5 year course of study that we undertake as students of this wonderful profession is both comprehensive and balanced. We practice on a daily basis for 5 years the art of adjusting the spine and peripheral joints in a safe and effective manner. Please keep this in mind the next time you tout Chiropractic as either unscientific or unsafe. We also spend thousands of hours learning the science behind what we do and the proposed mechanisms behind why it works. The third pillar to chiropractic used to be Philosophy but that side of the course has taken a back seat to make way for more and more science.

    Unfortunately most of the students were drawn to the profession by the amazing results they either saw occur in family and friends or felt occur in their own lives. However now we are told that anecdotes and testimonials mean nothing so long as there are no double blind randomized control trials to say that the treatment worked. We are being driven as a profession down the road of allopathy and I for one will fight to continue practicing Chiropractic the way it was passed on to us from our predecessors.

    I myself was drawn to Chiropractic after many sports related injuries were dragged out terribly by physiotherapists who were quite happy to continue applying non evidence based modalities to my injuries without any resolution. In several cases these injuries that could not be resolved by physiotherapy were indeed treated and resolved within 2-3 treatments by my trusted chiropractor.

    There are no solid studies to show why what we do works so well but it does. It definitely does. There are millions of people around the world that will attest to this.

    I would love to write more but I must get back to study to ensure that I am well equipped to assess and treat my upcoming patients with the best of my knowledge and ability.

    Cheers.

  20. theearthisflat says:

    I read with a smile the emotion, the ignorance and righteousness of particular contributors to this thread. People suggesting ‘their’ profession is more evidence based relative to another or even suggesting they ‘are’ evidence based. Fair dinkum.
    Anyone suggesting they are an evidence based practitioner simply doesn’t understand the ‘evidence’ that is currently availble – what ever level the evidence is (if you actually understand that there are levels of evidence, double blind placebo,…expert opinon,..etc , yeh you guys know ’em I’m sure. MMm, what makes an expert an expert?)
    To suggest for example that physio’s are evidence based is absolutely ridiculous. That statement suggests that everything physios do, from heat packs to ultrasound, is eviedenced based for that patients particular pathology. Rubbish.
    Moreover, and this has already been suggested, each profession is stealing from the others. Geez, physios do everyting these days, from massage (where’s the evidence) to HVLA’s (wheres the evidence) to orthosis (where’s the evidence) to Pilates, taping, hot packs, ultrasound (please check your crystal isn’t cracked,…), interferential , etc – where’s all the evidence!!
    Most of health, especially manual health is only ‘expert opinion’, or ‘clinically proven’
    (what ever that means,..and how is it regulated). Low grade evidence – that is what we use,..all day, every day. Show me otherwise people. Show me the plothora of the necessary level 1 evidence papers that proves that one profession is evidence based. Not a chance.
    Hence, for one profession to ridicule another for using ‘none evidence’ based protocols is irrational and hypocritical. Especially when those professions often use the very techniques and protocols they are ridiculing the other professions for.
    Not all that is important can be measured,..and not all that can be measured is important.

  21. G Dave says:

    Hi,

    Guaranteed the people sooking about chiropractic above have not even visited a chiropractor. They are the sort of people that cast judgement and go with the crowd.
    I was not sure when i first visited a chiropractor but I do not let any external source sway my judgement. I decide for myself. Personally, chiropractic was amazing for me. I tried every sort of therapy, including GP’s, and chiropractic work was by far the most effective. Chiropractic solved my vision problems and migraines through jaw work. My energy levels increased massively, my digestive issues fixed up, and my chronic shortness of breath was fixed. Personally, I will never visit a GP again. They are forced by the government to conduct 15 minute sessions in which they are supposed to diagnose some complex medical issues. A typical GP’s diagnosis- bed rest, fluids and try and reduce stress. Then prescribe drugs which treat symptoms and damage the liver in the mean time. The last time I went to see a GP i had never been more pissed off- went to see them for my chronic shortness of breath. I was in there for about 5 minutes and he stated stress. I tried to explain to him that I was not stressed and whether it could be anything else. “No, stress.” Real cause- neck was too far forward-received adjustment and now my neck is in the proper anatomical position and breathing has been perfect ever since. Was also low on magnesium.

    Moral of the story- grow some balls and form your own opinions based on actual experience-not media hype

  22. lily mast says:

    Chiropractic is not physiotherapy without the “unscientific bits”. Take away chiros from Australia and you are taking away MY choice as to who looks after MY healthcare. And going by the number of times I have been let down by medicine (three times I have been left off waiting lists by the same hospital for procedures I urgently needed), I do not appreciate people like you who have no idea what they are talking about tell me how I will be looking after my body. I do not go to the doctor. In fact, I could almost go without medicare altogether because I never get sick. And I hate to break it to you, but we have several GP’s who refer to us (but have to keep it secret) and who are willing to work in partnership with us for the good of the patient. You know, the people who have been suffering for such a long time that nothing seems to work for them anymore. And if patients don’t want to come back into our practice, you know what we do. Leave them alone.

    EEEEEEEEEEEEEEEK.

    The point of chiropractic is to facilitate healing within the body by way of improving the body’s ability to heal ITSELF. I have worked for some 12+ chiropractors at several different practices, and have received treatment from some 20+ chiropractors ranging from those who trained in the US and Canada to those from Phillips Institute (now RMIT), Macquarie and Murdoch universities. I like my chiropractors to know what they are talking about, and for them to undertake 5 years of study to want to help me be the best I can be is important to me. It raises them above the rest, and gives them the confidence and knowledge to rightly assess someone’s health so they don’t hurt anyone. They are preventative care. They don’t see the world that differently. Chiropractic treats the cause, not the symptom. That’s the real difference to me.

    Without chiropractic I wouldn’t be walking; I have spina bifida, and I stopped being able to move when I stopped going to the chiro (because I was a rebellious teen). Since then it’s kept my hyper mobility in check (because all my joints dislocate. Constantly) and it keeps my mind focused purely on the food I eat, the exercise I take and the way I look after myself now so that my old age will be comfortable and I will be able bodied for a long time to come. How I achieve that is surely my choice.

    And can I just say no one forces anyone to go to a chiropractor, I’m not exactly sure what everyone’s problem is. I mean, hell. Just get over it. We don’t tie up people the second they walk in the door and sign them up for life!! Why are you so afraid of people having choice and people getting better? Leave people alone, stop telling them what they should and shouldn’t think. Let them (shock horror) think for themselves!!!! I base my appreciation of chiropractic on the fact that it works for me and I like not having to spend $$ on drugs and stuff my body doesn’t need. Does that actually stop you from sleeping at night? That I *drum roll*….go to a chiropractor! Quick, to the internets, this lady needs saving from her own decision making!!!

    Go fight a real fight. The world is getting warmer and stuff you know……

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