A recent commenter advocated quite voceferously for chiropractic, specifically citing its supposed benefit in hyertension, one of the leading causes of morbidity and mortality in the U.S. In evaluating this claim, a few things need to be kept in mind.
First, there is no plausible explanation for why “adjusting the spine” should have any effect on arterial hypertension. This is important not just scientifically, but mathematically. For a rigorous treatment of this issue (stick with it) please see Kimball Atwoods series on the topic of prior probability.
Second, the few studies that have been done are, to say the least, unimpressive. PubMed and OVID MedLine both give under 30 hits for “chiropractic AND hypertension”. The searches lead to a number of pilot studies, but no studies of adequate power to measure a true effect. A particularly interesting study from a well-respected hypertension program (1). A pilot study is not powerful enough to show causation, but is simply a “proof of concept” used to show whether or not an idea is even worth pursuing. Most of the other studies are from fringe journals. The citation he gave from the Journal of Clinical Hypertension was, unfortunately, not available to me in full text, but does not appear to relate directly to chiropractic treatment of hypertension.
The evidence does not support the use of chiropractic to treat hypertension—ever. Hypertension is a complex, dangerous, and heterogeneous set of diseases, the treatments for which are quite well understood. All the wishing in the world won’t change that. The use of chiropractic for hypertension is a dangerous idea whose time will likely never come.
References:
1 Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B.Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.J Hum Hypertens. 2007 May;21(5):341-2.
March 17, 2008 at 4:26 pm
So then explain the results. Dangerous idea huh? Doctor tell me how many people die a year from properly perscribed medication?
March 17, 2008 at 4:40 pm
“Sure, your real car is better than my Barbie Beach Jeep, but can it fly? Didn’t think so!”
Yes, people still die. Modern medicine has not solved the mortality problem. It has, however, done much more for people than cracking backs.
March 17, 2008 at 4:54 pm
On the other hand if this turned out to be true it would turn your little world upside down. Has it occured to you that there may be a plausible explanation but you just don’t know about it?
March 17, 2008 at 4:56 pm
Sure. That’s what science is for. Go and use it.
If someone has an extraordinary claim, like cracking a back can improve blood pressure, then the burden falls on them to prove that the implausible claim might be true. If it is, wonderful.
March 17, 2008 at 5:03 pm
Would you get adjusted if they did prove it? Assuming you had hypertension.
March 17, 2008 at 5:08 pm
I think the study is actually here
http://www.nature.com/jhh/journal/v21/n5/abs/1002133a.html
An editorial about it is available
http://www.nature.com/jhh/journal/v21/n5/full/1002134a.html
The sample population was individuals with demonstrated anatomical abnormalities.
“According to a double-blind, placebo-controlled study design, hypertensive patients with documented evidence of vertebral misalignment were randomized either to a chiropractic vertebral realignment procedure or to a sham intervention.”
If there is documented misalignment, it isn’t a surprise that fixing the misalignment would help. In this particular patient population, a trial of realignment might be worth doing before surgery. Sort of like how a wrist brace is worth a try before carpal tunnel surgery.
March 17, 2008 at 5:09 pm
If chiropractic were proved to work for a particular condition as well as or better than conventional treatment, it would be adopted very quickly, and, yes, I would recommend it.
Obviously, my bias based on scientific fact is that this won’t happen, but if it does, I’ll be making an appointment.
March 17, 2008 at 5:11 pm
So, then by your standards you get adjusted for acute lowback pain?
March 17, 2008 at 5:39 pm
Chiropractic has been shown in some studies to be equivalent to standard care for some low back pain. Given that less expensive therapy works just as well (tylenol, stretches, heat, time), I have no particular interest in chriopractic at this time. If a patient just loves it, well, I don’t discourage it, since low back manipulation is probably safe.
March 17, 2008 at 5:48 pm
Then it is not all bad …or “Quackery” as you put it? Was there ever a time when you would have not have held the abouve opinion?
March 17, 2008 at 5:55 pm
Speaking of saftey did you see this publishe in spine (Spine has an 85% rejection rate):
Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver F, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Spine 2008; 33 (4S):S176-S183.
The study concludes: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.
March 17, 2008 at 5:59 pm
Given that chiropractic is based on imaginary beliefs (subluxation) has has shown to have modest benefit on basically one condition for which less expensive alternatives exist, yes, I’d say chiro is pretty much quackery—that being said, chiros who limit themselves to back pain and don’t try to explain things with imagniary spine disorders are pretty damned low on the quack scale. They might even be called proper physical therapists.
March 17, 2008 at 6:09 pm
Well doc coming from you that sounds like an endorsement. I think I’ll go home and take pride that I’m ” pretty damned low on the quackery scale.” Have a great evening!
Ill be back to keep you honest.
March 17, 2008 at 8:22 pm
The question is, were those VBA dissections diagnosed by the chiropractor? If not, how long was diagnosis delayed by the visit to the chiropractor?
Even if the chiropractor didn’t cause the VBA dissection, if treatment was delayed as a consequence that is nearly as bad.
March 18, 2008 at 5:33 am
This may be a stupid question, but what would be the chances of detecting this prior to dissection if you went to a GP? If the only symptom is a headache without any other symptoms, would you order a CT and if you did, would this dissection show up prior to more telling symptoms? And, if there are more telling s/s of a stroke, then I can’t imagine going to a chiropractor for treatment.
If a GP wouldn’t detect this condition prior to actual dissection, how would chiropractic delay treatment?
March 18, 2008 at 6:10 am
@ Peter
“Speaking of saftey did you see this publishe in spine (Spine has an 85% rejection rate):
Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver F, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Spine 2008; 33 (4S):S176-S183.
The study concludes: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”
Peter, here’s some criticism of that study, and its lead author, David Cassidy, which was written in a letter from Sharon Mathiason which you can find published at ChiroWatch. (FYI, Sharon Mathiason’s daughter died after having her neck manipulated by a chiropractor):
Quote:
“This new “study” itself is a review of billing records. No patient charts or tests were examined. There was no new scientific data. The authors took 819 strokes and then used billing records to see who had seen a doctor in the past year and who had seen a chiropractor. Considering that billing payments were very limited for chiropractors in Ontario and now thank God have been completely eliminated, this is a very poor record of the actual number of visits to a chiropractor. Did the scientists not realize this simple statistical fact?
Of course, the strokes caused by the chiropractors happened in their offices while none happened in the office of the doctors. Where did they tell us that? According to the logic of this study, if my daughter Laurie or anyone else saw your medical doctor in January and then had a stroke in December after having a neck manipulation, it did not count against the chiropractor. Almost everyone has seen their doctor within a year. You would get the same result if she had stopped at McDonald’s to buy a hamburger and then went to the chiropractor.
The Globe and Mail [a newspaper in which the study was recently featured] is also negligent in not identifying the principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as “all of the study’s authors conclusions are completely invalidated by their methods”.
David Cassidy, before he was dismissed from the University of Saskatchewan,was called as an “expert” witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest.
In the Globe and Mail article co-author David Cassidy is quoted “Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office”. Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome.”
More…
http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html
(Scroll down the link a little to locate the letter)
And here are a couple of additional comments on the study which I’ve lifted from a recent thread on an email discussion list:
“The design was not prospective and did not involve a comparison of the percentage of patients visiting each practitioner type having strokes.”
“My point was that you can’t simply look at numbers of patients who see an MD or chiropractor and say that the incidence of strokes is similar in the patient populations without characterizing those populations. That is hardly dismissive of evidence which is indeed alarming.”
As far as I can gather, the prevailing medical consensus, based on the current scientific evidence, is that there’s no justification for >90% of neck manipulations due to there being safer treatments available such as exercise or massage.
March 18, 2008 at 7:36 am
Again, the touchy-feely factor may be at work here, lowering stress levels. I wonder if anyone studied “hug therapy”.
March 18, 2008 at 9:17 am
John (aka Bill) Kinsinger (MD) has collected data on VB stroke and it is highly associated with chiropractic neck snaps. On the other hand, he has yet to find a case that was caused by a PT. He thinks the difference is both in selecting people who need neck manipulation (there are chiros who do that for everything) and better technique on the part of PTs.
March 18, 2008 at 9:52 am
It’s kind of cute how Peter thinks he is keeping PalMD honest. Awww, poor guy just needs his ego stroked.
March 18, 2008 at 10:59 am
Blue: The editorial review board over at spine disagrees with you. I’m sorry the study hurts your political agenda.
Chad: Your just jealous. PalMD proudly declares all chiropractic to be quackery yet he had to admit that this is not the case with acute low back pain. I’ll bet there was a time when he said ” chiropractic is no good for acute lowback pain.” This is a problem because if you were wrong about acute lowback pain then you may be wrong about other conditions, and yes this does stroke my ego!
March 18, 2008 at 11:18 am
Chiropractic can ease the suffering of acurt back pain until the 3 to 6 weeks are up and the natural time period for recovery is finished. It fairs about the same as drug therapy. Overall it is not much better than doing nothing, but people like it better.
Therefore, it is not correct or incorrect to either statement (”chiropractic is good/no good for acute back pain”). It just depends on the variable that you are measuring. Time to recovery is not significantly different. Patient satisfaction is better.
March 18, 2008 at 12:01 pm
Peter wrote “Blue: The editorial review board over at spine disagrees with you.”
Publication (even in a good journal) is just the first step in acceptance (or rejection) of an idea. Then, the rest of the scientific world gets to evaluate the research. In this case, the article was poorly refereed. For one thing, it was totally voluntary, so chiros with many complaints lodged against them were not represented.
Those who were in the study reported what they wanted to. The reports of any adverse events were low compared to those in better studies:
http://www.ncbi.nlm.nih.gov/pubmed/11239743?dopt=Abstract
“The most valid studies suggest that about half of all patients will experience adverse events after chiropractic SM. These events are usually mild and transient.”
In addition, 189 customers were lost to follow-up. If even one had a stroke, the calculation of the incidence of strokes in the article would be changed enormously.
Also, those parts of chiro that are not quackery (manipulative therapy for musculoskeletal conditions) can be done more safely and economically by other practitioners. That which is unique to chiropracty is pure quackery.
I’m sorry if that hurts your political agenda.
March 18, 2008 at 12:22 pm
Joe:
“Also, those parts of chiro that are not quackery (manipulative therapy for musculoskeletal conditions) can be done more safely and economically by other practitioners. That which is unique to chiropracty is pure quackery. ”
Show data please. Here is a list of data that refutes your assumption and will hurt your political agenda:
1 THE AGENCY ON HEALTH CARE POLICY AND RESEARCH STUDY
On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.
The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.
The following conclusions were made in this landmark study:
• Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
• Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.
Other interesting finds included:
• The risk of serious complications from lumbar spinal manipulation is rare;
• There is currently no evidence supporting the use of trigger point, ligamentous and facet injections, needle acupuncture or dry needling as treatment for acute back problems;
• The panel found no evidence of benefit from the application of physical agents and modalities such as ice, heat, massage, traction, ultrasound, cutaneous laser treatment, transcutaneous electrical nerve stimulation (T.E.N.S.) and biofeedback techniques.
Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (U.S. Department of Health and Human Services) -1994.
2. THE AUSTRALIAN STUDY- cost & pain-relief effective with a lower chronicity rate
In this Australian study, 1,996 workers’ compensation cases were evaluated in patients who experienced work-related mechanical low back pain. It was found that those individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those patients who received chiropractic care there was a significantly lower incidence of progression to a chronic low back pain status.
Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia - 1992;22:47-53.
3. THE RAND CORPORATION STUDY
Members of the Medical Community Recognize Chiropractic’s Effectiveness
This study, conducted by the prestigious RAND Corporation, marks the first time representatives of the U.S. medical community have gone on record stating that chiropractic is an appropriate treatment for certain low back pain conditions. A second, all-chiropractic panel’s ratings show agreement with the multidisciplinary panel that spinal manipulation is appropriate for specific kinds of low back pain. A utilization study examining chiropractic patients’ charts in multiple geographical locations in the United States is now underway. This will allow investigators to examine actual clinical cases and learn how prevalent each condition is in practice.
The RAND Corporation (”Research and Development”
is a nonprofit private corporation in Santa Monica, California. They conduct research and development for the U.S. government and private sector, commanding international respect. It’s research programs include classified defense research for the military, applied economics, education, sociology, civil justice and health sciences.
The Appropriateness of Spinal Manipulation for Lower Back Pain. Shekelle PG, et al. RAND Corporation, Santa Monica, California - 1992.
4. THE MANGA REPORT
As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.
Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.
The researchers also stated that studies on the prevalence and incidence of low back pain suggest that it is the leading cause of disability and morbidity in middle-aged persons, and is by far the most expensive source of workers’ compensation costs North America.
The Canadian Government report concluded with the following findings:
• On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate;
• There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain;
• Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by nonchiropractic professionals;
• There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management;
• There would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually;
• Workers’ compensation studies report that injured workers with the same specific diagnosis of low back pain returned to work much sooner when treated by chiropractors than by medical physicians;
• There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical physician management;
• The use of chiropractic has grown steadily over the years and chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians;
• In our view, the following offers an overwhelming case in favor of much greater use of chiropractic services in the management of low back pain:
o the effectiveness and cost effectiveness of chiropractic management of low back pain
o the untested, questionable or harmful nature of many current medical therapies
o the economic efficiency of chiropractic care for low back pain compared with medical care
o the safety of chiropractic care
o the higher satisfaction levels expressed by patients of chiropractors.
The following recommendations were also included in the report:
• There should be a shift in policy to encourage and prefer chiropractic services for most patients with low back pain;
• Chiropractic services should be fully insured under the Ontario Health Insurance Plan;
• Chiropractic services should be fully integrated into the health care system;
• Chiropractors should be employed by tertiary hospitals in Ontario;
• Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients’ needs;
• Chiropractic should have access to all pertinent patient records and tests from hospitals, physicians, and other health care professionals upon the consent of their patients;
• Since low back pain is of such significant concern to workers’ compensation, chiropractors should be engaged at a senior level by Workers’ Compensation Board to assess policy, procedures and treatment of workers with low back injuries;
• A very good case can be made for making chiropractors the gatekeepers for management of low back pain in the workers’ compensation system in Ontario;
• The government should make the requisite research funds and resources available for further clinical evaluations of chiropractic management of low back pain, and for further socioeconomic and policy research concerning the management of low back pain generally;
• Chiropractic education in Ontario should be in the multidisciplinary atmosphere of a university with appropriate public finding;
• Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physiotherapy professions.
The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. Pran Manga and Associates. University of Ottawa, Canada - 1993.
BACK TO MENU
5. THE AV-MED STUDY
In this study, 80 patients who previously received medical treatment were subsequently referred to the Silverman Chiropractic Center. Of the 80 patients, 21 percent had just been diagnosed with spinal disc problems, 12 percent had been diagnosed as requiring surgery and 5 percent had received emergency room treatment. Following chiropractic treatment, none of the patients were required to have surgery, 86 percent of the patients needed no further care, and the estimated health care savings in the group of 80 was estimated to be $250,000.
The Av-Med Study - 1993.
BACK TO MENU
6. THE MIDWEST RESEARCH INSTITUTE STUDY
This study examined clinical trials published in the professional literature between 1930 and 1981.
The researchers concluded that:
• manual therapy was superior to placebos,
• there was greater mobility following manipulation,
• the duration of treatment was shorter for the manipulated groups,
• there was improved lateral flexion and rotation after manipulation,
• the numerous case studies throughout the literature report the satisfaction of chiropractic patients with the outcome of treatments.
Chiropractic Evaluation Study Task III Report of the Relevant Literature. MRI Project No. 8533-D. MacDonald MJ, Morton L. For Department of Defense, OCHAMPUS, Aurora, Colorado - 1986.
7. THE ANNALS OF INTERNAL MEDICINE STUDY
The Third Most Widely Read Medical Journal Finds Chiropractic A Winner In Low Back Pain
The use, complications, and efficacy of spinal manipulation for low back pain was reviewed in the Annals of Internal Medicine, the third most widely read medical journal. The article concluded that spinal manipulation clearly helps patients with uncomplicated, acute low back pain.
Spinal Manipulation for Low Back Pain. Shekelle P, et al. Annals of Internal Medicine - 1992;117:590-598.
8. THE UTAH STUDY - fewer costs and days lost
This 1988 Utah workers’ compensation board study found a tenfold savings for mean compensation costs in back-related injuries treated by chiropractors as compared with medical doctors ($68.38 vs. $668.39). To ensure accurate and true results, only those back-related injuries with the same diagnostic codes were compared between the two treatment groups. Also, the medical treatments assessed were limited to nonsurgical medical treatments only.
Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine - 1991;33:847-52.
9.THE FLORIDA STUDY - shorter disability/lower costs/lower hospitalization rates
This large State of Florida study examined 10,652 patients who sustained back-related injuries on the job. Their findings revealed that individuals who received chiropractic care compared with standard medical care for similar diagnoses experienced had a (i) 51.3 percent shorter temporary total disability duration (ii) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case) (iii) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.
An Analysis of Florida Workers’ Compensation Medical Claims for Back Related Injuries. Wolk S. Foundation for Chiropractic Education and Research, Arlington, VA. - 1988.
10. THE CALIFORNIA STUDY - chiropractic patients get back to work sooner
In this study, Richard Wolf, M.D. followed 500 individuals sent for chiropractic treatments and 500 individuals sent to medical doctors for treatment. Those who received chiropractic treatments returned to work in an average of 15.6 days vs. 32 days in those who received treatments from medical doctors.
Industrial Back Injury. Wolf CR. International Review of Chiropractic - 1974;26:6-7.
11.THE OREGON STUDY- chiropractic gets individuals back to work, and fast!
This Oregon study found that individuals with workers’ compensation claims returned to work significantly faster under chiropractic care compared with medical care. In fact, under chiropractic care 82% were able to return to work after one week compared with only 41% in those who received medical care.
A Study of Time Loss Back Claims. Portland, OR. Workers’ Compensation Board, State of Oregon, March 1971.
March 18, 2008 at 12:27 pm
@ Peter
“Blue: The editorial review board over at spine disagrees with you. I’m sorry the study hurts your political agenda.”
Irrelevant.
The editorial review board over at Spine needs to be more thorough.
For any readers wishing to learn more about the current state of chiropractic in the USA, this 42-minute presentation is well worth a view:
The Kinsinger Report on Chiropractic 2008
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv
And for any readers wishing to learn about the current state of chiropractic in the UK, this is well worth a read:
Value of chiropractors questioned
http://www.skeptics.org.uk/forum/showthread.php?t=1610
@ palMD
Thanks for the great posts.
March 18, 2008 at 12:40 pm
Blue:
“The editorial review board over at Spine needs to be more thorough.”
They reject 85% of the submitted studies. Do you think they WANT to help chiropractors?
March 18, 2008 at 1:06 pm
I don’t think “helping chiropractors” should be their job.
March 18, 2008 at 1:17 pm
My point exactly
March 18, 2008 at 2:06 pm
The point is, one or two low-powered studies is not a lot of evidence to recommend a therapy that is based on imaginary anatomy. When overwhelming evidence becomes available (for instance, the evidence seen with thiazide diuretics or ACE-inhibitors), then chiropractic will get a little more cred.
March 18, 2008 at 2:22 pm
@ Peter
“Blue:
They reject 85% of the submitted studies.”
Well let’s hope that their publishing of the Cassidy et al study is simply an embarrassing mistake and not a sign that they’re starting to get sloppy.
@ Joe
There was also a very questionable study on the safety of chiropractic published in the UK recently which concluded that although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low. See here:
Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H3CXkGBZlZtPyLtFwhPrfgWQpPTQk 3mD0WBzhpyBP4LVX6xmHJ7K!-383192544!181195628!8091!-1
However, this is what Professor Edzard Ernst, the world’s leading scientific expert on complementary and alternative medicine (who applies scientific rigour to assessing them), had to say about it:
Quote:
“This is a most laudable attempt to define how often serious adverse effects of cervical manipulation happen. To generate certainty, such studies need to be very large, must not lose patients to follow-up and have to rely on accurate reporting. The sample of this survey was sizeable but not large enough to exclude rare events. Thus the authors can only state that, at worst, the risk of serious adverse events within 7 days after manipulation is 2 per 10,000 treatment consultations. If the average patient has a series of 10 treatments, this risk could therefore be as high as 1 in 500 per patient. Given the nature of the risk, i.e. stroke or death, this is by no means negligible.
The picture gets more complicated when considering the 698 treatment consultations of patients who failed to return for their next treatment. Theoretically some or most or all of these patients could have died of a stroke. Overlooking even one single serious adverse event would change the estimated incidence rates from this study quite dramatically.
In my view, the most confusing aspect about the results of this survey is the fact that the incidence of minor adverse events is so low. Previous studies have repeatedly shown it to be around 50%. The discrepancy requires an explanation. There could be several but mine goes as follows: the participating chiropractors were highly self-selected. Thus they were sufficiently experienced to select low-risk patients (in violation of the protocol). This explains the low rate of minor adverse events and begs the question whether the incidence of serious adverse events is reliable.
Studies of this nature are very difficult to conduct such that we can trust the results. One of the problems is that one has to rely on the honesty of the participating therapists who could have a very strong interest in generating a reassuring yet unreliable picture about the safety of their intervention.”
The safety of chiropractic cervical manipulation
Focus on Alternative and Complementary Therapies, Vol.13. Issue 1. March 2008, pp43-44
http://www.medicinescomplete.com/journals/fact/current/fact1301a07g04.htm
[Subscription only]
More from Ernst in his paper ‘A critical evaluation of chiropractic’ which was published in last month’s Journal of Pain and Symptom Management:
Quote:
“Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.
Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation, and spinal manipulation, are not based on sound science.
Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.
Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence.
Its cost-effectiveness has not been demonstrated beyond reasonable doubt.”
http://www.ncbi.nlm.nih.gov/pubmed/18280103?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
More from him here too:
Spinal manipulation: Are the benefits worth the risks?
http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf
Not very reassuring reading.
March 18, 2008 at 3:59 pm
Fiction not supported by fact is what it is Blue.
March 18, 2008 at 4:46 pm
Peter, I can not respond to a data dump. Why don’t you go to a forum, with a thread for chiro. The one suggested by Blue Wode is good.
http://www.skeptics.org.uk/forum/showthread.php?t=1610
Or, start a new thread “The Value of chiro is unquestionable” since the first is already so long. Go to
http://www.skeptics.org.uk/forum/forumdisplay.php?f=6
and start under “Alternative Medicine.”
Then, pick one thing that chiros get right, and make that claim and support it. Note, many chiros do effective, manipulative therapy for low back pain; but that is not really chiro since lots of health professionals (e.g., PTs) do it too.
March 19, 2008 at 8:19 am
@Peter
What is your background in Chiropracty? What do you think it can do?
March 19, 2008 at 8:34 am
This is a little off topic, but there are studies that purport to show that transcendental meditation can lower blood pressure. The problem is, most of these studies seem to be funded/run by the TM people. Your thoughts?
Marilyn
March 19, 2008 at 11:20 am
@Marilyn
I’m not surprised that relaxing with your eyes closed for 20 minutes reduces your blood pressure! I find staying in bed all morning works quite well too, and doesn’t cost me £20.
July 15, 2008 at 6:53 pm
Funny, it sure works for me.