Chiropractic science or quackery new story

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Chiropractic science or quackery new story

Postby guest » Tue May 25, 2004 9:04 am

Science or Quackery?
A campaign by five families reignites the debate over the chiropractic industry

Danielle Smith
Calgary Herald

Saturday, May 22, 2004

Twenty-year-old Laurie Jean Mathiason died a violent, horrible death. An autopsy found she had a traumatic rupture of the left vertebral artery; it was not only just torn on the inside lining, it was punctured through.

When the tearing occurred, blood spilled into the cavity of her brain, creating such intense pressure in her skull, brain tissue was squeezed down to the bottom of her spinal cord. She was declared brain dead within 24 hours.

What caused this trauma?

Chiropractic neck manipulation gone wrong.

On April 30, the families of Mathiason, Lana Dale Lewis, Donna Claire Fawcett, Renate Dora Labonte and Dr. Ron Grainger -- all dead as a consequence of similar neck treatments for minor ailments -- sent a booklet and videotape to 400 politicians, with an appeal for an immediate moratorium on chiropractic adjustments that involve the top two vertebrae of the neck. It is a request that deserves a serious hearing.

This group does not want to stop chiropractic treatment on the lower neck, lower back or any of the other safer services offered by chiropractors. They do not want to stop funding chiropractic services.

They want provincial health ministers to take three months to investigate whether there is any medical merit to the practice of cracking the neck to treat illness, and whether the benefits of such a practice outweigh the risks.

After watching the home video made by the families of these victims (and others who have suffered stroke, paralysis and quadriplegia), one requires no expertise in chiropractics to see it is not only a reasonable request, but an urgent one.

The purpose of chiropractic treatment is to detect and correct spinal misalignments (called subluxations) which, it is thought, can irritate the nerves and interfere with proper energy flow. Once vertebrae are brought back into alignment, energy flow is restored, allowing the body to heal itself.

So, upper neck manipulation does not just benefit patients with neck pain, headaches and whiplash, it can also be used to treat, well, almost everything.

A binder full of chiropractic brochures contains remarkable claims: neck and back manipulation can treat gall stones, arthritis, heart trouble, eye trouble, constipation, colds, tonsillitis, appendicitis, cirrhosis, diabetes -- the list is endless.

The brochure for treatment of diabetes states: "with normal vertebral alignment re-established, the nerve supply can again freely reach the affected area, permitting the body to maintain normal metabolism."

The family-produced video includes footage which shows a baby getting its neck cracked, as an alternative to immunization. Brochures advertise the treatment of childhood fevers, asthma, allergies, colic, bedwetting, ADHD, and learning disabilities.

What politicians need to ask is, how widespread are these treatments and where's the proof any of it works?

In a 2001 paper, three professors of chiropractic condemned the largest professional associations in the U.S. and Canada for producing and distributing these pamphlets, saying they "make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable."

Yet it continues. One Calgary area chiropractor was advertising last year to draw patients in for an adjustment to protect against West Nile virus and SARS. That is not medicine, nor is it sound science.

Why aren't regulatory agencies doing something about it?

In conventional medicine, a pharmaceutical company can't get a product on the shelf until it's gone through four stages of testing. If any consumer product were sold based on exaggerated promises, it would be penalized by regulators, forced to publicly retract its claims and refund customers' money. If the consequences were benign, perhaps there would be little reason to pursue it. In some cases, it appears the consequences are anything but benign.

The chiropractors point to a 2002 article in the Annals of Internal Medicine, a journal of the American College of Physicians, to support their claim that neck manipulation is safe.

It states, "The apparent rarity of these accidental events has made it difficult to assess the magnitude of the complication risk."

The article was written by chiropractors and is -- in the words of medical doctor and chiropractic critic Stephen Barrett -- "a one-sided puff piece" in which they "either ignore or attempt to obfuscate information about chiropractic's shortcomings."

Further, on its website, the College of Chiropractors of Alberta points to research by Walter Herzog, associate dean of research, faculty of kinesiology, at the University of Calgary.

His study concludes neck adjustment is done well within the normal range of motion, that no force is applied to the arteries during an adjustment, and that arteries are not stretched -- rendering unlikely that damage would occur to vertebral arteries during neck adjustment.

Herzog's critics say his research is not reliable because it was conducted on cadavers, (five dead people aged 80 to 99), he placed the devices measuring the pressure in the wrong place on the artery, and that pressure isn't the main issue anyway -- the strokes that are resulting in death and disability are typically caused by blood clotting from damage to the interior of the artery.

All Herzog proved was that dead people can't have strokes.

Meanwhile there are 60 academic studies, published in peer-reviewed journals, that link chiropractic neck manipulation to incidents of stroke.

Barrett contends the chiropractic profession "has not made a serious effort to study the incidence" of complications resulting from neck adjustment.

For instance, an article from the October 2001 Canadian Medical Association Journal calculates a rate of one in eight million office visits, based on a study of malpractice data. But it's not remotely accurate.

The equivalent would be like trying to calculate the number of auto injury accidents based solely on the cases that make it to court.

In a January 2002 article for the Canadian Medical Association Journal, professor Edward Ernst writes there is "convincing evidence" spinal manipulation has "frequent, mild adverse effects as well as serious complications of unknown incidence."

At least one study estimates the risk of complication as high as 1 in 5,000.

Is further investigation not warranted?

In the 2002-03 fiscal year, Alberta taxpayers forked over $38.5 million to Alberta's 745 chiropractors, an average billing of $51,725 each. Alberta Health pays $12.66 per visit per patient, to an annual maximum of $200.

If the incidence of permanent disability is as high as one in 5,000, that would mean that since there were 3,043,585 treatments performed last year, 609 people are dead, paralysed or suffering the after-effects of stroke -- all paid for by the health-care system, and all as a consequence of treatment for minor maladies such as back pain, headaches and sinus congestion.

Is it really worth the risk?

Our politicians need to find out.

In its most recent budget, the Liberal government of Ontario de-insured chiropractic care, which will save Ontario taxpayers more than $100 million a year. It's time the Alberta government struck a committee to gain more knowledge into the risks of chiropractic and consider whether public funding should continue.

Florida chiropractic school news article

Postby malernee » Sat Jun 05, 2004 5:43 am

Testing the board's authority
A Times Editorial
Published June 4, 2004

Florida's Constitution now insists that lawmakers keep their noses out of
university programs, but that didn't stop them from creating a chiropractic
school, of all things, this year. Regrettably, the people who are supposed
to oversee universities, the Board of Governors, did little more than vent
their frustrations at their meeting last month.
The chiropractic school, fashioned for Florida State University, is largely
the brainchild of a chiropractor, Sen. Dennis Jones, who has held
influential positions in the Legislature. It would be the only such school
on any university campus in the United States, a form of education that a
2000 FSU consultant's report euphemistically called "unique." But the proper
role of universities in the teaching of alternative medicines is the least
of the questions facing the governors board.

The Legislature's $9-million chiropractic school appropriation is a direct
affront to the board's authority, which was duly noted in an animated
dialogue on the subject. Zach Zachariah, a board member who is a Fort
Lauderdale cardiologist and Republican fundraiser, was emphatic. "We have
the authority," he said. "In my opinion, there's no question. We have to
stand up."

Instead, the board opted, on an 8-5 vote, to sit down - at least for now.
Miguel DeGrandy, who is a former lawmaker, advised his colleagues: "I don't
think this is one where we want to cause a rift with the Legislature. We
have to pick our fights carefully."

DeGrandy's point about diplomacy is well-taken. The board is new, and its
constitutional standing is untested. It will have to build a working
relationship with the Legislature, which ultimately holds the purse strings
to all of state spending. But the chiropractic manipulation is no less an
affront to higher education by virtue of the fact that its legislative roots
extend farther than the board itself. Voters approved a separate governing
agency precisely because they wanted to stop this kind of meddling.

The Board of Governors is also in the midst of refereeing a fight over new
medical schools, and the three universities hoping to build those costly
programs will be watching to see if the end-around approach works for the
FSU chiropractic school.
To some extent, the angry debate is an encouraging sign. The board, after
all, was created over the objections of the same governor, Jeb Bush, who
then appointed 15 of the 17 members. The first chairman, Jacksonville
businessman Tom Petway, turned over most of the board's duties, including
the selection of a chancellor, to Education Commissioner Jim Horne before
quitting four months later to campaign for President Bush. A year later,
Chairwoman Carolyn Roberts, a former university regent, says she thinks the
new board ultimately "will take the appropriate action to protect our

The chiropractic school will at some point have to bring its education plan
to the Board of Governors for review, which means this fight is not
necessarily over. The board, not the Legislature, is supposed to establish
program priorities, and it is hard to see how chiropractic education would
be high on the list.

© Copyright 2003 St. Petersburg Times. All rights reserved
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Spinal Manipulation Better Than Sham

Postby malernee » Sat Oct 16, 2004 11:14 am

Spinal Manipulation Better Than Sham Therapies for Low Back Pain
Ann Intern Med. 2003;138:871-881, 898-906

Laurie Barclay, MD
Medscape Medical News 2003. © 2003 Medscape

June 2, 2003 - Two systematic review articles published in the June 3 issue of the Annals of Internal Medicine look at the use of manual therapy for low back pain. The first shows that there is no evidence that spinal manipulation is superior to other standard treatments for chronic low back pain. The second finds evidence that massage and spinal manipulation may have small clinical benefits, but there is a lack of evidence for acupuncture. Massage therapy may be the only manual therapy that offers a reduction in healthcare costs.

"Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of [spinal manipulative] therapy for low back pain," write Willem J. J. Assendelft, MD, PhD, from the Cochrane Back Review Group, and colleagues. "We conclude that spinal manipulative therapy is one of several options of only modest effectiveness for patients with low back pain."

This meta-analysis identified 39 randomized controlled trials from MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and previous systematic reviews.

Spinal manipulative therapy was clinically and statistically superior only to sham manipulation or to the group of therapies judged to be ineffective or even harmful, such as traction, corset, bed rest, home care, topical gel, no treatment, and minimal massage. Compared with sham therapy, the difference on a 100-mm visual analogue scale was 10 mm (95% confidence interval, 2 - 17 mm).

There was no evidence that spinal manipulative therapy was either superior or inferior to other recommended therapies, including analgesics, exercises, physical therapy, and education about back injury prevention and ways to deal with back pain (back school).

The authors report no potential financial conflicts of interest, and this study had no external funding.

In the second review, the authors extracted data from systematic reviews of randomized controlled trials published since 1995, including 20 evaluating the effectiveness, safety, and cost of acupuncture, three evaluating massage therapy, and 26 evaluating spinal manipulation for persistent back pain.

All of these treatments appeared to be relatively safe. Massage had some benefit and was the only modality that reduced healthcare costs. Spinal manipulative therapy had small clinical benefits comparable to those of analgesics, physical therapy, or back exercises. Because of the poor quality of the trials, the effectiveness of acupuncture remains unclear.

"Because there is growing evidence that patient expectations affect outcomes, allowing patients to choose the treatment they believe will be most helpful may improve results," the authors write. "The decisions to offer complementary and alternative medicine therapies to patients should consider effectiveness, safety, costs, the relative effectiveness of these therapies compared with conventional treatments, and patient preferences and expectations."

The second author is the former research director of the Northwest Institute of Acupuncture and Oriental Medicine.

Ann Intern Med. 2003;138:871-881, 898-906
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one horse vets opinion about chiropractic

Postby malernee » Sat Oct 16, 2004 11:16 am

"Veterinary Chiropractic"

If you have a dog, cat, or horse, you may find yourself invited to have its spine "adjusted." Before taking any such plunge, here's what you should know.

No part of chiropractic education deals with animals, and no part of veterinary education deals with manipulative forms of physiotherapy. In most states, the practice of chiropractic is, by definition, restricted to humans (a definition supported by a 1998 decision of the appeals court of the state of Michigan). Nevertheless, some chiropractors purport to be able to ply their trade on animals [A, B} and some veterinarians [B].say that they can perform chiropractic adjustments. One Wisconsin chiropractor, for example, says that "Chiropractic care offers a natural, drug-free adjunct to . . . total health care" and is suitable for cats, dogs, and horses with: back, neck, leg, or tail pain; carpal tunnel syndrome; degenerative arthritis; disc problems; head tilt; injuries resulting from slips, falls; TMJ problems, difficulty chewing; pain syndromes; sciatic neuralgia; sudden changes in behavior or personality; uneven muscle development; uneven pelvis or hips; weight loss due to pain; "a look of apprehension or pain in the facial expression"; and various other problems [1].

A few doctors hold both chiropractic and veterinary degrees. There also appear to be many animal "chiropractors" who are neither veterinarian nor chiropractor but assert that they have experience.

From a legal perspective, practicing on animals is restricted to veterinarians in all states. Technically, chiropractors may work on animals under the direct supervision of a veterinarian if the veterinarian feels that such treatment is warranted. However, in doing so, the chiropractor is working as an unlicensed veterinary technician. Under the same umbrella, a chiropractor might also be able to draw blood or take x-rays of an animal if properly supervised. Accordingly, anyone manipulating animals who is not a veterinarian or working under direct veterinary supervision is likely to be breaking current laws.

The American Veterinary Chiropractic Association (AVCA) of Port Byron, Illinois, "certifies" DVMs or DCs after 150 hours of coursework and also offers "advanced" courses. The idea that 150 hours can provide a chiropractic or veterinary education seems odd, and the Association does say that its certification is just the beginning. As scanty as 150 hours may seem, one-day seminars are offered on animal adjusting. What would the response be if members of the veterinary profession started giving one-day clinics on human chiropractic?

Sadly, many of human chiropractic's unscientific aspects are being applied to animals. For example, in a chapter in 1998 textbook intended for veterinarians, AVCA founder Sharon Willoughby, DVM, DC, states:

Chiropractors identify subluxations of the spine during clinical examinations and then proceed to correct these lesions by specifically adjusting the involved segments. . . . An adjustment is a specific physical action designed to reinforce the biomechanics of the verterbral column and indirectly influence neurologic function. . . .

For the veterinarian who understands the elements of holistic practice and the philosophy of chiropractic, every patient becomes a possible chiropractic patient. Every examination should include a spinal examination, and every treatment protocol should include an adjustment if necessary [2].

Some "veterinary chiropractic" advocates assert that spinal problems result in problems with other organ systems. In the above-mentioned texbook, "holistic veterinarian" Joyce C. Harmon, DVM, writes:

Many practitioners believe that the spine is not worth checking unless a musculoskeletal problem is being examined; however, every cell in the body has a nerve supply originating in the nervous system. The nervous system is therefore important to the health of all organ systems, and a chiropractic examination is advised for every patient. . . .

Chiropractic is an excellent way to build a veterinary practice because it includes preventive care after the initial problem is solved [3].

Some organs and cells function independently of nerve supply; and there is no reason to believe that spinal adjustment in humans does much besides loosening tight spinal joints. But even if chiropractic's subluxation theories were completely valid, it should be obvious from a mechanical standpoint that the forces on the spine of an animal that walks on four limbs are quite different from those of humans who walk on two. Thus, even if human chiropractic theories were plausible, direct application to animals might not be warranted. For example, since the vertebrae of horses are the size of the adult fist and surrounded by muscle, tendon, and ligament layers several inches thick, it seems reasonable to wonder whether equine vertebrae can actually be manipulated.

Of course, all of these concerns beg the question of whether "adjusting" dogs, cats, or horses really works. No scientific studies show that chiropractic adjustment does anything useful in any animal. It may be reasonable to surmise that moving an animal's limbs around, massaging its muscles, or giving it any sort of attention might be well-received by the animal, but there is no evidence that such attention can improve health. Furthermore, no published study has ever shown how a chiropractic-related problem can be diagnosed in animals or how treatment success can be determined.

There are also potential dangers. Chiropractic manipulation in humans usually entails short, thrusting movements applied at segments of the spine or at specific joints. Horses have been injured by overly aggressive maneuvers described as animal "chiropractic." Manipulating the spine of a dog with a degenerative disk carries the risk of severe and permanent harm to the spinal cord. No part of chiropractic theory suggests that mallets, hammers or boards -- devices that have made an appearance in the horse world -- should ever be used. (Indeed, the chiropractic-veterinary group itself decries the use of such devices.) Dramatic movements that stretch beyond the limits of normal range of motion -- for example, the lifting of a horse's hind leg over its back -- are potentially harmful. Nor should any animal be manipulated under tranquilization or general anesthesia.

It's easy to see how owners who want to do the "best" for their pets could be convinced by unscrupulous or naïve professionals that "people need adjusting -- animals must, too!" The human-animal bond is strong. However, that bond should not be abused under the guise of unproven "therapy." There is no scientific evidence that any animal ailment is amenable to spinal manipulation. The current state of affairs should be as embarrassing to chiropractors, at least those that are ethical and/or science-minded, as it is to ethical and science-minded veterinarians. Sadly, the animals stand mute.

1.Kaufman Chiropractic. Downloaded Jan 24, 1999. (States that referral from a veterinarian is required.)
2. Willoughby S. Chiropractic care. In Schoen AM, Wynn SG. Alternative and Complementary Veterinary Medicine: Principles and Practices. St. Louis: Mosby, 1998, pp 185-200.
3. Harmon JC. Incorporating holistic medicine into equine practice. In Alternative and Complementary Veterinary Medicine: Principles and Practices. St. Louis: Mosby, 1998, pp 631-647.
The observation below was taken from a vet boarded in neurology about chiropractic care.

Equally important, of course, is the question of whether there is any benefit, because the risk: benefit ratio should be considered when recommending treatment. In the absence of any controlled trials, I would like to offer the following observations.

I have seen rare cases where clinical signs worsened during chiropractic adjustment. For example, I evaluated a Doberman with neck pain. Radiographs showed changes suggestive of Wobblers in the caudal neck and a calcified disk in situ at C2-3. The client, a human chiropractor, declined myelography; she wanted the x-rays so that she could adjust the dog. Five days later, the dog suffered acute nonambulatory tetraparesis. X-rays showed the C2-3 disk was now in the vertebral canal. The dog recovered with surgery.

Now, of course this could have happened without any chiropractic adjustment. Thus, the difficulty in evaluating any treatment without controlled clinical trials. I would love to hear other experiences and thoughts.
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