Chiropractors are offering 'worthless' form of treatment

[RedEarth]

THERE is no evidence that spinal manipulation, a technique practised by 16,000 chiropractors in Britain, works, according to a study published yesterday.
A review of the evidence by Professor Edzard Ernst and Peter Canter, experts on alternative medicine, finds no convincing data to support claims that the technique is effective. With the possible exception of the relief of back pain — where spinal manipulation is as good but no better than conventional treatments — the technique is worthless, the review in the Journal of the Royal Society of Medicine concludes.



Professor Ernst, who is based at the Peninsula Medical School, Exeter, said: “The findings are of concern because chiropractors and osteopaths are regulated by statute in the UK. Patients and the public at large perceive regulation as proof of the usefulness of treatment. Yet the findings presented here show a gap and contradiction between the effectiveness of intervention and the evidence.”

The British Chiropractic Association reacted angrily to the findings. In a statement, it said that it was disappointed that the RSM would publish such a “biased” article. “Ernst and Canter have carefully selected negative articles in support of their conclusion that manipulation cannot be recommended as a treatment when national clinical practice guidelines, based on much more and better research than the studies this article has selected, have come to exactly the opposite conclusion,” the statement said. “The usefulness of manipulation is that it can be added, substituted or modified as part of a package of care that provides management, pain control, advice and recognises risks to a good recovery.”

http://www.timesonline.co.uk/article/0,,8122-2097779,00.html

[niallmac]

1. My own personal study.

I have yet to discover anyone who went to a chiropractor, had an xray taken and was told; "Good news! There is absolutely nothing wrong with your spine."

[seriousstan]

2. Proof positive timesonline is worthless.

Chiropractors are offering 'worthless' form of treatment? No, say it isn't soooooo.....

[SeveneightyWhoa]

22. Attacking the media for presenting the truth?

Hmmm, analagous to another situation I'm thinking of..

[FloridaPat]

3. I know 2 people who were helped by a chiropractor. I know lots

more who got nothing for their money - myself included.

[HuckleB]

8. Sounds like the rate of success of a placebo.

[Warpy]

4. However, studies of patients with acute back injury

has shown that chiropractic can reduce the number of days of disability, and in some cases, the exercises given by chiropractos together with those given in a standard rehab situation can often forestall the need for surgery for several years in the case of severe disk injury.

However, if one of those guys pulls the "one leg is longer" trick, run like hell.

[HuckleB]

9. Same thing happens if you see a PT.

And a PT doesn't make as many claims not based in research, so I'll stick with a PT in said situations.

[FM Arouet666]

5. Cancel Christmas, an holy epiphany.

Quack goes the chiropractic duck.

[Celebration]

6. Cured by a Crunch

http://www.telegraph.co.uk/health/main.jhtml?view=DETAILS&grid=P8&xml=/health/2006/03/23/hosteo21.xml


Both sides examined in this piece-- Remember that with a "review" of other studies, it is quite easy to self select certain studies out of the review by manipulating the criteria on which studies will be selected, and which not.

No surprise then that the professor's findings have been roundly rejected by chiropractors and osteopaths alike, who have criticised both the methodology of his research and his conclusions, and accused him of waging a campaign against practitioners.

"This report is misleading," says David Byfield, head of the Welsh Institute of Chiropractic at the University of Glamorgan. "Ernst has said spinal manipulation is not effective for an aggregate of diverse conditions, and for some reason he has included back pain alongside infant colic, allergies and asthma.

"Very few of our patients come to us with infant colic. They come with headaches and back and neck pain, for which spinal manipulation can be very effective."

This article was a straight news article until the end, when the author recounted her own experience with a chiropractor.

The freeing up of my upper back sent signals to my nervous system that abruptly altered the blood supply, said Savory, which was why I suddenly felt lighter and more flexible. Two weeks on, my back feels fantastic. Spinal manipulation may not be for everyone but it worked for me.

[HuckleB]

10. Where are the placebo-controlled studies...

showing that chiropractic care helps for headaches and the like?

[Celebration]

11. placebo chiropractic

Is probably not that easy to do. Here is what I did find--

http://healthychoice.epnet.com/GetContent.asp?siteid=upmc&docid=/tnp/condition/tensionha

Chiropractic Spinal Manipulation
Neck tension can cause tension and pain in the head. Such “cervicogenic headaches” overlap closely with tension headaches. Chiropractic spinal manipulation has shown some promise for these conditions, but the evidence is incomplete and somewhat contradictory.

In a controlled trial of 150 participants, investigators compared spinal manipulation to the drug amitriptyline for the treatment of chronic tension-type headaches. 8 By the end of the 6-week treatment period, participants in both groups had improved similarly. However, 4 weeks after treatment was stopped, people who had received spinal manipulation showed statistically significantly better reduction in headache intensity and frequency and used fewer over-the-counter medications than those who had used the amitriptyline.

In another positive trial, 53 participants with cervicogenic headaches received chiropractic spinal manipulation or laser acupuncture plus massage. 9 Chiropractic manipulation was more effective.

However, a similar study of 75 participants with recurrent tension headaches found no difference between the two groups. 10 Other, smaller studies of spinal manipulation have been reported as well, with mixed results.

In a recent controlled trial, 200 people with cervicogenic headaches were randomly assigned to receive one of four therapies: manipulation, a special exercise technique, exercise plus manipulation, or no therapy. 12 Each participant received at least eight to 12 treatments over a period of 6 weeks. All three treatment approaches produced better results than no treatment, and approximately the same effect as each other. These results prove little, however, since any treatment whatsoever will generally produce better results than no treatment, for a number of reasons having nothing to do with the treatment itself. Ordinarily, researchers get around this problem by using double-blind, placebo-controlled trials (For more information on this important subject, see Why Does The Natural Pharmacist Rely on Double-blind Studies?) While it isn’t possible to do a truly double-blind trial of chiropractic, the better trials noted previously used a form of placebo treatment, making them more reliable than this one.

By the way, the placebo effect in knee surgery is apparent very high. The sham surgery patients even did a little better. Have we stopped doing these operations because of the results?

http://www.chiropracticresearch.org/News_sham_knee_surgery_just_as_good_a.htm

Honesty, I don't know.

[HuckleB]

12. Placebo control is never easy.

It is necessary, however. It's done with acupuncture, and is showing a number of areas where acupuncture is clearly beneficial to placebo. So, I don't think chiropractors can be let off the hook.

[Celebration]

14. my recollection

I keep looking for this study I remember that came out a few years ago, and it used chiropractic, sham chiropractic, and orthopedic treatment (I think?). It was a kind of weird result with chiropractic and sham chiropractic (another kind of "false" adjustment I suppose) being about equally effective, and both beating orthopedic treatment. So naturally that started another discussion-- "see, chiropractic is only the placebo effect" vs. "well who cares sham chiropractic is better than orthopedic treatment"--and on and on. Intellectually speaking I am more in the latter camp. If a certain treatment modality has a particularly high placebo effect, that seems a plus rather than a minus.

To be fair, I feel the same way about the knee surgery that has a particularly large placebo effect, but isn't different from the real surgery. I don't know, I just think feeling better is the goal, you know?

I think controlled studies are a good idea, but I would take--seeing a chiropractor vs. taking pills.

[HuckleB]

16. Chiropractor vs. pills.

Depends on what you're treating. Pills are not inherently evil.

[Celebration]

17. I meant a STUDY of chiropractic vs. pills

Did not make myself clear, sorry.

[HuckleB]

20. Only if those pills are proven against placebo.

And the chiropractic care is proven against placebo.

Without that information, such studies would have too many confounding factors to give good information.

[HuckleB]

7. Old news. New edition, I suppose.

As noted in other threads, the placebo effect is real, and it appears (over and over again) that the placebo effect is all that chiropractors offer.

[bemildred]

13. So do conventional MDs.

A conventional doctor will sell you plenty of worthless "treatment", and for a higher price, too.

[HuckleB]

15. A higher price?

LOL! Hardly.

What is a "conventional doctor" anyway? I don't believe I've had the pleasure of meeting one.

[beam me up scottie]

18. pssssssst!

(they call them "allopaths")

You know, like the ones who helped my dad beat cancer.

Twice.

I'd hardly call that worthless.


Of course, they didn't correct his subluxations, perhaps he should request a refund?

:D

[HuckleB]

21. LOL!

Salud!

[bemildred]

23. The $11,000 lemon

Americans pay the world's highest prices for prescription drugs, doctors, hospital stays and clinic visits -- an average last year of about $6,000 for every single person in the country. For businesses that offer health insurance to their workers -- and fewer and fewer are doing so -- the high cost of care translates into high-cost premiums: roughly $11,000 annually for each family covered. That's like buying a new car every other year.

But along with the world's highest prices, we get the world's finest care, right?

No. In fact, Americans get appropriate medical care just 55 percent of the time, according to the most comprehensive study of treatment quality to date. If we extend the analogy a bit, that's like paying for a new car every other year, but winding up with a lemon that spends half its time in the shop.

The study, conducted by the RAND Corporation think tank and published earlier this month in the New England Journal of Medicine, focused only on the testing and treatment regimens that have been researched and shown to be effective. This what the medical community refers to as the "standard of care." Yet the care actually received by American patients met those standards -- the standards medical professionals set for themselves -- only about half the time.

http://www.stltoday.com/stltoday/news/stories.nsf/editorialcommentary/story/2B847C9B51894B8D8625713F004978A1?OpenDocument

[HuckleB]

24. Nice propaganda.

Spin is spin, no matter what side it comes from. No one says our health care system is wonderful. In fact, all you've done is try to divert attention from your original comment.

Why is that?

[Sgent]

19. Just to mention

that Osteopath's in the US & UK are completely different animals. For the vast majority of practicing osteopath's in the US, they haven't done OMT since med school -- and that was required.

In the US, DO=MD for all intents and purposes, same licensing requirements, same required training, same tests. The few DO's that I know that still use OMT use it rarely and in the case of backpain and other areas where it's known to work.