As I’m sure many of you are aware, on 25 Feb 2010 a report entitled ‘Effectiveness of manual therapies: the UK evidence report’ was published. The report was commissioned by the General Chiropractic Council (GCC) in June 2009 and Prof Bronfort and his team started work on it in the same month. The cost of the report to the GCC was $20,000, which seems really quite reasonable (particularly as it’s $$$ and not £££). It was intended to provide a clear statement on the level of evidence to support certain claims made by many chiropractors in the UK.
Blogger Zeno covers this in more detail here: Zeno’s Blog: Talking the talk
The report, associated tables and commentaries can be found here http://www.gcc-uk.org/page.cfm?page_id=1396 along with the GCC’s guidance on advertising claims.
A copy of the report can be downloaded (bottom of page) here: http://www.chiroandosteo.com/content/18/1/3 along with a summary of the Background, Methods, Results and Conclusions.
I was particularly interested in reading the reports findings regarding colic and asthma as well as a range of other non-musculoskeletal conditions that often appear on chiropractors websites.
Having read the report and its conclusions it is clear that those who have been questioning colic claims over the past couple of years, have been totally justified in being openly sceptical of these claims. The report clearly states that there is no evidence to support them. Actually it goes a little further and states there is ‘Moderate Negative’ evidence for spinal manipulation as a treatment option for both colic and asthma based on the best quality evidence currently available.
However, having had a quick read of the report, it seemed to me (a complete layman) there were a few things that were not as clear as they could be, so perhaps the GCC would be willing to answer a few questions. I will say now that the GCC were very good in providing prompt replies, often answering within a couple of hours, even when outside of normal office hours.
I found some of the answers quite interesting and some of the information was certainly not ‘clear’ from reading the report. The GCC had already told me they were in the process of updating their Patient Information Leaflet and had taken advice from CAP Copy Advice Team on the matter. The new leaflet is now available on their website.
However, I wanted to know exactly what the GCC thought was acceptable to claim and would they be issuing any direct advertising advice to its members regarding what can, or more importantly, what cannot now be published on websites. Their response was:
The GCC’s guidance to the profession mirrors that of the Committee of Advertising Practice Copy Advice Team ie that any claims for chiropractic must be based on best research of the highest quality. This will almost certainly mean randomised controlled trials that produce high or moderate quality positive evidence.
This reply was given on more that one occasion, and they did emphasis that ‘best research of the highest quality’ and RCT’s producing ‘high or moderate quality positive evidence’ were now the required standard on which any claims must be based. However the GCC seem reluctant to take the next obvious step and issue some direct, unambiguous advice that would help remove any posibility of further complaints being submitted.
Not all the findings are totally clear and could be open to individual interpretation. The report lists three categories of ‘Inconclusive’ evidence, so where does that leave claims for conditions in these categories. From a chiropractors perspective the most beneficial on would be the ‘Inconclusive, but favourable evidence’. Clearly this falls outside the standards set earlier for high or moderate, positive evidence and the report clearly says “Does not support any public claims regarding effectiveness”, although some of the other wording does seem to allow them a get out clause of “Advise patients that this is a treatment option in the absence of an effective alternative” How many chiropractors will actually turn paying customers away and suggest an effective alternative.
I did push them a little further to see it they were willing to issue any specific advice to chiropractors, even if just for those conditions classed as ‘Inconclusive’. The response was to restate their above comments, but interestingly they also added:
I hope you will appreciate that the Council must be careful not to prejudice the consideration by the statutory Investigating Committee of a significant number of current complaints about the content of chiropractors’ websites.
Now correct me if I’ve got the wrong end of the stick, but they’ve just issued a report that says there is no reliable evidence to support asthma or colic. Doesn’t that automatically go some way to influencing the outcome of a number of the complaints!
Those of you who have read the report will see that it lists the findings of 26 conditions, split between three areas (musculoskeletal, headache, non-musculoskeletal), but there seem to be a number of conditions like ADHD, Breastfeeding and Dyslexia (and others) that are missing from the report. They certainly don’t appear on every chiropractors website, but they’re not uncommon.
I asked the GCC what their view was on these conditions and the others not listed in the report. The reply was quite interesting and not something I’d seen mentioned in the report or elsewhere (if I’m wrong, please let me know!). It seems that the initial remit of the report was to investigate every condition listed on any website where the GCC were in receipt of a complaint.
Thank you for your further communication. I think it will be helpful for me to clarify that Professor Bronfort was asked to consider every condition, sign and symptom that was mentioned on any of the websites in respect of which the GCC has received complaints. This included ADHD, difficulties with breastfeeding and dyslexia. Where any condition does not appear in the report, this is because no relevant randomised controlled trials were identified.
Obviously this will help the GCC’s Investigating Committee clear up many of the complaints it still has on its books!
Importantly for chiropractors (and sceptics) it is quite clear on the fact that if a condition was NOT included in the report, it is because there’s NO relevant evidence (RCTs) to support that claim. These conditions must therefore fall well below the required level of evidence needed to make any public claims.
The GCC were also kind enough to provide a list of all the conditions and symptoms that the review was initially asked to consider. It is less of a list and more of a breakdown of conditions listed by website where a complaint has been received. All references to the website and details of the complaint had been removed.
The list of conditions (as supplied) can be found here: ‘conditions ‘ list supplied XXXXXXXX 10 March 10-REDACTED ( Can anybody turn this into a proper list? )
So this all seems to suggest that the only conditions chiropractors can openly advertise (at present) are those actually listed in the report as having the high or moderate levels of positive evidence. These are the only conditions where it is stated chiropractors can say “Supports public favourable claims regarding effectiveness” and “advise patients that this is an effective treatment choice”
I also think it’s safe to assume that this report would never have been commissioned at all if it hadn’t been for the high number of complaints submitted to the GCC and the pressure that has put on the chiropractic profession. With the release of this report the GCC have now set the standard it expects the profession to follow, now it’s up to their members to reach that standard …..
…….. So will chiropractors be willing to accept the report and take down any remaining unsupported claims !
Finn
July 20, 2010
Yes, “infantile”. When an argument for the use of a modality is so flawed, but repeated without examination, the logic is “infantile” in its maturity.
Finn
July 20, 2010
Look this up on YouTube and you will undoubtedly find a chiro selling this:
DRX9000 Spinal Decompression Therapy:: Degenerative Disc Disease
http://www.youtube.com/watch?v=fvxUadnvmgw
BOGUS and you all know it. YouTube (one example of many out there) is full of this garbage and chiros are guilty of promoting therapies for which there is simply no evidence for and yet they do not acknowledge this.
Finn
July 20, 2010
Fed Up,
I just took a stroll back through this thread, and it is strikingly apparent that you know absolutely nothing about science and scientific research whatsoever.
I don’t know what kind of evangelical chiro college you attended, but I don’t see much evidence of science in your arguments.
fedup
July 20, 2010
Finn, I’m not a scientist and when I trained as a chiropractor EBM was not considered.Patient outcomes were the most important factors. EBM is important to physio as without it they wouldn’t get paid by the NHS, which is why most private physio’s on the web use McKenzie, interferential etc ie non ebm methods. I have said this god knows how many time, I don’t use the title DR. I have never advertised or claimed to treat any child hood illnesses,I have never worked on anybody under the age of 8, I don’t use the term subluxation and so far this year everybody that has come into my room has complained of musculo-skeletal problems. I do not like the way some people advertise their services, I do not like any form of scaremongering, I don’t claim to be able to cure anything. When a new patient comes into my room I tell them that I will try and help but I can’t guarantee anything, I advise them that if they don’t feel significantly better by their 3rd visit then there is probably no point continuing.
I can stop US chiros from advertising about as much as you can stop Physios advertising McKenzie. Yesterday, I had a lady show me the execises she was given by her NHS physio, they were hand drawn,(by the physio) stick men on a tatty bit of A4 paper, what are you going to do about that?
I don’t do research, I work, i’m too busy, but I would gladly take part in any research project.
Finn
July 20, 2010
Fed Up,
Yes, patient outcomes are what is most important, but if you don’t do the research that supports or refutes efficacy, how on earth can you possibly say that your therapy is what caused the change in the outcome? You make claims that chiro treatment is what benefitted the patient, but you are not in the place of authority to make that conclusion–you are connecting dots that you are not in the position to. How can you control for the natural course of healing that accompanies every healing process? Yet, you take the credit for this without providing any evidence whatsoever except anecdote.
As for EBP, you are erecting straw men. What kind of systematic assessment of the clinical practice of PT is it when you use Google? Have you ever actually tried using evidence for your claims….? Here you are doing it once again, making claims, now of other professions, without doing the due diligence of seeking out the best evidence. And why do you keep side-stepping into PT?
Why do you refuse to acknowledge your own profession in this? You have never addressed this except now to say that you, personally, do not partake in this. You see however, this is not about YOU, nor is it about ME. Of course I could never endorse scribbles on a paper, but I am not aware of the context of this example, so again, it is anecdotal.
The fact is that chiro does not engage as a profession, in EBP. It does not engage in high quality research. Simply because you do not do the research (you “work”), does not absolve your profession for engaging in this research. Where is this research? It does not exist to any degree that supports chiro., and even many in the chiro community acknowledge that this is problematic.
In the end, the issue is that chiro as a profession, is based on an unsupportable premise, makes extraordinary claims, does very little credible research to support these claims, doesn’t seem to care one wit about this, and then denies all of this when confronted, pointing fingers elsewhere.
The Singh case has demonstrated this perfectly.
fed up
July 20, 2010
OK Finn, how many physios in private practice do you know that use only EBM? And you still haven’t given me a single bit of information about what you actually do. What are these EBM protocols that you stick so close too?
“Yes, patient outcomes are what is most important, but if you don’t do the research that supports or refutes efficacy, how on earth can you possibly say that your therapy is what caused the change in the outcome? You make claims that chiro treatment is what benefitted the patient, but you are not in the place of authority to make that conclusion–you are connecting dots that you are not in the position to. How can you control for the natural course of healing that accompanies every healing process? Yet, you take the credit for this without providing any evidence whatsoever except anecdote.”
Isn’t this what physios have been doing for years with McKenzie, traction, interferential etc? I have easily found research that shows that these are not beneficial, yet physios have used them as therapy for years. They still do.
Here the Guardian recommends it for neck pain. http://www.guardian.co.uk/lifeandstyle/besttreatments/neck-pain-treatments
Don’t get me wrong, I’m not saying these treatments are ineffective, I’m saying that your profession is very similair to the chiropractic profession.
If you perceive EBM to be the only course of action then I’m afaid you are blinkered.
“Evidence-based medicine in practice defi nes the
likelihood of something happening. It is never
100%. It is not absolute truth. Evidence never tells
you what to do. The same evidence applied in one
case may not apply in another. The circumstances
of the individual may be different, or the
circumstances may be the same, but patients may
refuse one treatment in favor of another. What
evidence-based medicine does is inform one about
what the best options are—but it doesn’t make the
decision.”
fed up
July 20, 2010
David Sackett warns against lockstep adherence
to scientific evidence, computerized or otherwise.
As author of the EBM definition and a professor
at Britain’s National Health Service Research and
Development Centre for Evidence Based Medicine,
he writes,
“Without clinical expertise, practice risks
becoming tyrannised by evidence, for even
excellent external evidence may be inapplicable to
or inappropriate for an individual patient.”
Finn
July 20, 2010
Fed Up,
You seem to feel that asking questions of others answer those put to you. How does this work?
First off, I did not ever claim that PT’s in private practice “use only EBP”, in part, because I simply don’t have that information and it would be speculation. However, I did already (twice) refer to this query of yours. The issue is whether there is incentive from within the profession, as expressed through the university programs that offer PT programs. This is in stark contrast to chiro where there is absolutely NO mandate whatsoever of Evidence-based Practice to be found.
You have yet to address this.
You keep referring to McKenzie, traction, interferential, and yet I have also addressed this, acknowledging that you are correct in assertaining that there is little evidence for the efficacy of these modalities. I have twice gone on to explain (YOU ARE NOT READING) that despite this, and becuase of this, PT students for the past 10-15 years have been educated to EBP and you will find very few recent graduates who use these for exactly the reason that research in the area has demonstrated their ineffectiveness.
You say, “I’m saying that your profession is very similair to the chiropractic profession”. Are you mad? You have got to be joking!!!! How many PTs are flogging themselves on YouTube selling all kinds of crap as are chiros? (I get the distinct feeling that you are not reading anything that I am writing!!!) Physios do not use Vega machines, or sell people on Axial decompression (aka traction with Christmas ornaments), or sell them on repeat visits for spinal manips., or tell folks that adjustments “correct the spine”, or that “vital energy” is being “blocked” and that adjustments will restore this……ad nauseum….PT’s do NOT do this!!!! Chiros do, whether you do personally or not is irrelevant.
You know absoletly nothing about evidence based practice. It does not dictate that nothing be done if absolute causation or 100% evidence of efficacy cannot be demonstrtated. It is a progression within a profession, of research and clinical practice passing back and forth, allowing for an evolution of the profession. Chiro does not do the research and has never evolved past Palmer claiming that he could cure deafness with a crack of some fool’s back. EBP provides guidance, not absolutes, but without it, you have no clude at all….and that is chiro in a nutshell….everybody gets the crack, some lumbar, some SI, some thoracic/CV, and some c-spine….but everybody gets a crack and is then told that they must return of the magic will where off…..and your assiciations tell you that this is good for business.
Sorry pal, but that is not PT, not even close. You will never hear a PT tell a patient that what the PT does will help them stop smoking!! Yet, chiros make all sorts of insane claims, and you have not once addressed this!
I know very well who Sackett is–we spent much time discussing his writings along with Gord Guyatt, etc. I am very well versed with this concept, but you still have not addressed what happens when you do no research and have no evidence whatsoever to base any clinical decision-making on…and that is chiro.
How about enough with the avoidance and just address the problems of your profession instead of the silly dnace that you seem to be really practiced at?
Chiros are, for the most part, a bunch of quacks who would sell as many people as possible on the promise without much else. Where is the research to support these claims made by chiros?
If you perceive EBM to be the only course of action then I’m afaid you are blinkered
fed up
July 21, 2010
Finn again please enlighten me as to the EBM you use in daily practice. What techniques proven by research do you apply? Do you work with people?
“If you perceive EBM to be the only course of action then I’m afaid you are blinkered” so what position should it hold and when should non ebm techniques used?
Physios don’t use vega machine?
http://www.gotosee.co.uk/practitioner/St-Margarets-Complementary-Therapy-Clinic-Twickenham-Richmond.htm
Or axial decompression?
And some times a good crack can help.
http://search.pedro.org.au/pedro/browserecord.php?record_id=3660
Just spoke to a physio that thinks your wrong, probably not got much experience outside of the NHS. But of course thats anectodal which to you means didn’t happen or is not real.
fed up
July 21, 2010
http://www.greatlakes-physiotherapy.com/physiotherapy-traction-decompression.html
They some times use Reiki.
http://www.josmitholiver.com/therapies.php
some feel the need for further training in manipulation.
http://www.macpweb.org/home/
fed up
July 21, 2010
OK Finn I’m using this resource to find a suitable treatment from a physio backed up by good research. I’m having difficulty finding anything that physios usually use. Excersise programs might help but they can’t figure out which may or may not work.
Please let me know what you use so I can check.
http://www.physiotherapychoices.org.au/
Finn
July 21, 2010
Fed Up,
Why won’t you deal with this issue that has been placed at your feet.
Enough with the denialism.
Chirpractic is QUACKERY!
Finn
July 21, 2010
I too must work and I am quite tired by you complete side step of this issue.
Simply by trolling around the Internet, anyone can find webistes and anyone can find sources of exception, but the generalization is that chiros do not use research as part of evidence-based practice to guide them. EBP is simply not something that guides your profession. So, what does that have to do with another profession such as PT? Why won’t you accept responsiblity for your profession insofar as acknowledging this? It is endeminc to the chirp profession.
It was the chiros who were exposed by Simon Singh, not some other profesion, and you simply will not accept that as reality.
Chiros are all over YouTube making claims about all sorts of crap. This is the business angle of chiros and that is why the public and the medical profession sees chiros as snake oil salesmen.
Denying as you do here, does not change that.
Finn
July 21, 2010
I just took a look through some of these websites that you posted. Come on man, I have already said that the vast majority of the professionals who do adopt EBP do not use modlaities for which there is little evidence. Of course there are exceptions.
However, we are not talking about the exceptions, so please, grow up and stop using these strawmen as your argument.
You continue to deny that chiro as a profession is seen as promiting bogus treatments, as an entire profession!!! AS AN ENTIRE PROFESSION, not as exceptions, one here, another there.
Finn
July 21, 2010
I just took a look through some of these websites that you posted. Come on man, I have already said that the vast majority of the professionals who do adopt EBP do not use modalities for which there is little evidence. Of course there are exceptions.
However, we are not talking about the exceptions, so please, grow up and stop using these strawmen as your argument.
You continue to deny that chiro as a profession is seen as promiting bogus treatments, as an entire profession!!! AS AN ENTIRE PROFESSION, not as exceptions, one here, another there.
Imagine, chiro associations telling their members that they should promote this crap? Imagine these associations telling their chiro members how to get folks coming back for MAINTANANCE!! Repeat visits for what?? What kind of nonsense is this man??
You are a whck job if you think that you can side step this issue and someone walk away having defended the indefensible.
It is not about someone else, or some other profession. If you want to argue about PT, then please feel free to do so, but on another board where that is being discussed.
Chiro is QUACKERY.
Finn
July 21, 2010
What is probably the single most damaging aspect to the chiro profession is the perception of dishonesty. Your continued attempts at side-stepping the topic at hand (do you recall what it was?) and denialism is what makes both thepublic and the medical profession extremely suspicious of chiros.
That is why people describe chiros as “quacks” and “hucksters” of healthcare.
fed up
July 21, 2010
LOL, calm down Finn.
You said this. “Physios do not use Vega machines, or sell people on Axial decompression” I proved you wrong, getting a bit defensive. I agree with you regards the youtube crap. It is the worst part of my profession. It’s American.
“AS AN ENTIRE PROFESSION” again you are wrong, we are not all the same, we don’t work in the same way, we don’t all MARKET ourselves in the way. Labelling every chiro as the same as some nuttter on a youtube chiro video is pathetic. You are wrong about those exeptions aswell, the only reason there are not more links is because this site doesn’t let you post many links per post.
My question about physio (you) is purely down to the fact that you claim Chiro is not EBM. You state EBM is the way forward but give no examples. I use chiro techniques, you call that quackery. You use EBM what does that mean? Enlighten me.
As for the public being suspicious i think you are way wide of the mark.You really have no idea.
“Why won’t you accept responsiblity for your profession insofar as acknowledging this?” WTF are you mad? Oh it’s my fault is it? LOL Why should I accept responsibility when I’ve already made it clear I don’t make these claims?
“Chiro is QUACKERY.” spoken like a true, narrow minded, blinkered skeptic. Well done.
Finn
July 21, 2010
Fed Up,
Whe entire associations that represent thousands of members offer as guidance strategies for REPEAT VISITS for MAINTANANCE, that right there sounds the alarm bells. Forget everything else, that is enough to remove all credibility from any healthcare profession.
Add to that, that the claims made are simply not at all supported by evidence, is enough and has been enough, for highly regarded medical professional and health scientists to condemn the profession of chiropractic altogether as QUACKERY.
I did not ever say that you could not find a single example of a PT using unsubstantiated modalities, and yes, how abept you are at finding such exceptional examples. And this somehow absolves chiro how?
Your profession is notorious for the promotion of unsubstantiated methods that lack a scientifically plausible rationale. That is what quackery is.
What is “vertebral subluxation” and why is the chiropractic profession based on this and taught it within the curricula?
What is “innate intellligence” and “vitalism” and why is it taught in the curricula of chiropractic colleges?
Why do chiros claim to “treat” infant colic effectively?
Why do chiros treat bed-wetting effectively?
Instead of listing for you, I will let you take the time to do this. Start with the Simon Singh case…and I guess you will tell me that he was off the mark too?? He referred to chiros claims as “bogus”…. If the BCS was so sure of their case against his claim of this, then why would they back down and drop the case?
Here is why you should take responsibilty for these claims, because your association, and the college that trained you, promoted these tenets, and they are simply wrong or completely devoid of scientific fact, and you are an extension of them, regardless of whther you claim to adhere to them or not.
The discussion is not about you, but the profession at large. You try to use specific examples of PT’s engaging in less than EBP, and yet, you get defensive in saying that you are not to blame because, you claim, you do not promote the quackery that is being exposed in chiro. Let’s try to be consitent, shall we? How about sticking to this discussion, which is about a profession, at large, that engages in and protomtes itself in these manners….It is not about exceptions, but about attitudes and philosophies that underlie the profession.
Yes, this is why the medical professions and scientists in general, have such a problem with chiros and other “alternative” approaches that do not provide support for there claims and then continue to deny that there is a problem with that…..
And that is why the Singh case was so damning to chiro., because it exposed chiro as a profession (not just one or two), for promoting “BOGUS” treatments.
That is what QUACKERY is!
Fedup
July 21, 2010
Ok Finn don’t think we’ll get much further. There is good and bad (cough) in all wlks of life .The good news is that I feel my views, actions and thoughts shouldn’t be classed as representative of my profession. I KNOW yours arn’t of yours. Long live EBM, er whatever that is if your a physio.
Ps any physio actually practicing ebm for low back pain in a hosp, I would genuinely like to know what you do.
Fedup
July 21, 2010
Oh yes. I’m notin the bca!
Finn
July 21, 2010
Fed Up,
As this entire thread has been upon the issue of making claims that cannot be substantiated, BY THE PROFESSION OF CHIROPRACTIC, then once again, exceptions are not an issue.
What is important is THE FACT that there is no credible research base available to support the majority of the claims made by chiros that do not involve acute, uncomplicated LBP. If the chiro profession stuck to the treatment of musculoskeletal conditions in which there would be at least a glint of principled basis, but when the profession treads on ice that cannot support it by talking about infants requiring adjustments, regularly even, then that is the point at which the alrms bells go off in a big way.
Whether you choose a clinical approach that differs from this, is again, not an issue.
Finn
July 21, 2010
Fed Up,
As for your cryptic comment about the BCA, “Oh yes. I’m notin the bca!”, I bothered to mention the BCA, for one, because this association represents over 50% of the chiros in the UK. It is an example of how the public and medical community alike came to see how chiros represented themselves. Membership is voluntary, but the publicity that the BCA garnered in the Singh case was not limited to its members, nor was it limited to the UK. People all over the globe have read of the farce of chiropractic, based to a large extent, on the paucity of supportive research literature that the BCA could provide in its attempt to sue Simon Singh. That is why I mentioned it, but you seem to flippantly disregard this as if it is of some other planet. In drawing such attention to itself, it has acted as a lightening rod for the entire chiro profession.
The publicity produced by the BCA’s libel action has led to formal complaints of false advertising being made against more than 500 individual chiropractors within one 24 hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: “If you have a website, take it down NOW.” and “Finally, we strongly suggest you do NOT discuss this with others, especially patients”.
There is no way that by pointing fingers elsewhere, you can come close to undoing the damage that was done to the credibility of the chiro profession, publically and of the medical community.
Time for the QUACKERY to see the sunshine!
fed up
July 22, 2010
Finn, you may say I’m to blame as I’m a chiropractor, but I have done nothing of the above. I didn’t take down my website and I often talk to patients about what has been happening. I haven’t got a complaint against me (yet). And I only deal with musculoskeletal complaints. I trained as a chiropractor, I use chiropractic techniques, I am very busy(full day today).I produced my own leaflets, helped by my physio brother, and still use them. This BCA v Singh debarcle hasn’t affected me one jot! What should I start to call myself?
Finn
July 22, 2010
Fed Up,
Apparently YOU have not been reading. I have never once said “YOU” other than in a collective sense, when I offer comment. The profession of chiro and the farce that it has allowed itself to become is not about exceptions, but about the very specific and deliberate behaviours of the chiro associations that represent a majority of their members.
If this issue has so little to do with you, then why continue to comment on it? To continue to do so will simply see you either defending the indefensible actions of the profession, or trying to claim that it does not represent you. In either case, it does not address the issue that is set forth here, which is that the chiro profession does not support a research agenda that is anything more than propaganda, nor does it encourage self-examination of self-criticism as a form of active evolution. Rather, it promotes its claims of benefit, that are for the most part, supported by nonsensical constructs of vertebral subluxation, vitalism and innate intelligence. Furthermore, as a profession, it refuses to acknowledge that the evidence to support even the claims within the realm of musculoskeletal conditions is not sufficiently robust. The profession does not seem to rein in members who make fantastical claims until something like the Singh case forces this change.
The Singh case has not finished causing significant changes in attitude in many domains, so I think that your assertion that this claim has “hasn’t affected me one jot!”, is very much premature. Such a comment is the same steadfast, stubborn refusal of the chiro profession to evolve scientifically since its inception 100 years ago.
Quackery!
fed up
July 23, 2010
Finn I am a chiropractor, Iam not unique, I know lots of chiropractors like me, who work in a similair way, but you brand the whole of the chiropractic profession based on youtube.
As for research you are wrong. check your pedro physio data base and you will find over 250 research papers. Check chiro&osteo web site and you will find hundreds more. Every chiropractic grad has done at least 1 piece of research.
To say “which is that the chiro profession does not support a research agenda that is anything more than propaganda”
, “nor does it encourage self-examination of self-criticism as a form of active evolution.” again this shows your complete ignorance when it comes to chiropractic and how it has evolved over the years.
“refusal of the chiro profession to evolve scientifically since its inception 100 years ago.”
I will shout. YOU DON’T KNOW WHAT YOU ARE TALKING ABOUT.
To base everything you do on EBM is very restrictive, this is why the charteered society of physios have this in their cop/sop.
“A rigid and narrow definition of scope of practice restricts opportunity and
innovation for both individuals and the profession by placing fixed limits on the
boundaries of practice which are not sensitive to changes in the health and social care environment. It is however acknowledged that a defined scope of practice may support the grass roots of the profession by setting clear parameters for newly qualified physiotherapists and a basis of understanding for the public. This must not, however, restrict reasonable practice for those established and experienced in their careers. It is, therefore, not appropriate for the profession to list the modalities available or practiced as this will ossify the profession, prevent development of
practice and maintain out of date and potentially dangerous practices.”
This is you I take it. It’s why you can’t see past the blinkers. “setting clear parameters for newly qualified physiotherapists”
It also why many physio still use techs that have evidence to show they don’t work.
“The CSP supports individual physiotherapists who wish to develop their practice, and apply their skills in new roles while retaining a philosophical basis of physiotherapy.” Why is this not acceptable for chiropractors?
“The Curriculum Framework for Physiotherapy (2002)(6) defines physiotherapy as:
‘A health care profession concerned with human function and movement and
maximising potential. It uses physical approaches to promote, maintain and
restore physical, psychological and social well-being, taking account of
variations in health status. It is science-based, committed to extending,
applying, evaluating and reviewing the evidence that underpins and informs its
practice and delivery. The exercise of clinical judgement and informed
interpretation is at its core’.
Well being? what does that mean exactly? Clinical judgement and informed interpretation, I suppose it’s depends on how you interprit the evidence.
“In modern healthcare, skills are no longer unique to one professional grouping and there is a growing blurring of professional boundaries so it is now therefore
inappropriate to publish a list of activities that are deemed ‘in’ or ‘out’ of scope of practice; instead activities should be linked to the four pillars of physiotherapy”
What ? surely every thing that is not EBM should be out?
“Consequently physiotherapists are obliged to seek and adopt new and
innovative ways of working within the framework of evidence-based practice, whilst also understanding the historical roots of physiotherapy practice which underpin the profession’s development.”
Again why is it so wrong for chiros to be taught it’s historical roots? And don’t shout about EBM as there is plenty of research been done for chiropractic and plenty of physios using non ebm methods.
Finn
July 23, 2010
Fed Up,
I DO NOT base my argument that the profession of chiropractic is one way or another, on “YouTube” as the primary source of information. YouTube is only one example, but this entire forum was started by someone else, and the issue NEVER referred to YouTube. I would be much more comfortable using a source of information that was much more verifiable (as opposed to YouTube) and that is why I used the example of the BCA v Simon Singh case. Because it was a court case that involved an association that was the face for over 50% of the chiros in the UK, it is much more representative of what the profession projects out to the community. As well, because the BCA has at its means the resources to find and demonstrated scientific evidence to support its case, then it is a much better example to use.
You continue to try to deflect your argument onto physiotherapy and this discussion is not about the weaknesses of physio. Those weaknesses within PT (or any profession), whatever they may be, do not absolve chiro. in any way and to continue to use this is unjustified. Forget physio and deal with the profession of chiro.
Secondly, you do not know anything about research or about doing high quality research, and neither do most of your peers based on the paucity of high quality research papers published in peer-reviewed journals. I am sorry, but simply because something is “published”, in and of itself does not make it high quality research. That fact was made glaringly evidence when the BCA could come up with only 29 papers IN TOTAL that it felt supported chiro. Of those 29 papers, most were nowhere near high enough quality to be considered “supportive”. The result was simply an embarrassment. Please do not sit there and write about research and hide behind your own lack of research expertise and in that ignorance, claim that there is research to support chiro., because that is incorrect, THERE IS NOT, FULL STOP.
If, as you claim, “Every chiropractic grad has done at least 1 piece of research”, why does that not translate to published research in credible, peer-reviewed journals? What is important is not that they can put togeehter some poster for their student peers, but that their research efforts are published and critically appraised by a variety of scientists in the research world. This simply does NOT happen in chiro.
Yes I do know what I am talking about because the lack of published research to support the efficacy of chiro is what this entire argument hinges upon. It is your lack of research savvy that makes you unable to actually discuss this and it is this that you share with your professional community.
I have never said that EBP is the Holy Grail. Never have I said this. Of course there must be room for applying the evidence onto a specific situation and every patient/cliet is unique. HOWEVER, what I have said is that chiro has NO EVIDENCE BASE ON WHICH TO GUIDE CLINICAL DECISION-MAKING AT ALL. And that is the whole point of this discussion and what the Singh case exposed…..
The chiropractic profession has so very little high quality evidence of its efficacy, combined with a theoretical construct that is not based in science, that chiros have no other means than anecdote to guide them. How can a profession expect to be taken seriously with this as its basis?
The answer is that its credibility has been undermined by the most recent exposure provided by the Singh case. This case however, is certainly not some sort of anomalous blip. Anyone with an expertise in health science research methodology would have pointed this out long ago, as is the case.
You ask what is wrong with chiros being taught about historical roots? It depends on the context of those roots. Ask the same question about present day Germany. Most Germans can easily identify that Hitler, while charismatic, led the country into one of the darkest period of modern history. Fortunately, modern Germany has rejected Hilter as having had any kind of positive influence on their country, which makes pretty good sense.
Obviously for a much less drastic reason, why doesn’t the chiro community admit that Palmer was a but of a kook, and made up some goofy stuff which was based in nothing but nonsense. Yet, many in the choir profession continue to use the same terms that were direct consequences of Palmer, such as “vitalism”, innate intelligence”, “and vertebral subluxation”. This is a deliberate choice by the profession not to evolve past this, in part, by refusing to do the research that would allow it to move forward.
I am sorry, but you are simply wrong when you claim that the chiro profession does this high quality research. If you are correct, where is it? Why couldn’t the BCA do better then. If anyone could have, they would have provided the very best research there was…and look what they came up with.
I am sorry Fed Up, you argument is left wanting. Your profession is Quackery, whether or not you claim to be part of the majority or not is irrelevant.
fed up
July 24, 2010
Nice of you to eventually prove a point with Godwins law.
You keep going back to the Singh cases that was based totally on child hood ailments. Yes many chiros made claims about these, but not all. So the profession as a whole cannot be blamed.
Again, I’ll draw you back the lack of progress in my profession.
This shows chiropractic has changed. http://books.google.co.uk/books?id=xRGhUSdwCgQC&pg=PA26&lpg=PA26&dq=chiropractic+evolved&source=bl&ots=lECpjxOJ26&sig=F3x6KQgWvx6zefFIZD-vQkLOhK4&hl=en&ei=brpKTP–BoWUjAf3kb3XDA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CBgQ6AEwAQ#v=onepage&q=chiropractic%20evolved&f=false
maybe you should look over your shoulder,
“Conclusions: Although the mechanical equipment has changed, the therapeutic goals of spinal traction have advanced very little over the past 5500 years. Most recent traction methods have made little contribution to the advancement of spinal traction, with the exception of the construction of redundant equipment.”
And here are physios still using traction.
http://www.physiobob.com/forum/general-physiotherapy-discussion/144-lumbar-traction-aggrevates-pain.html.
There are hundreds more. Shall I copy and paste them? Shall I start to say all physiotherapy is bogus not just the ones using a 5500 year old therapy that has no evidence to back it up?
fed up
July 24, 2010
“so I think that your assertion that this claim has “hasn’t affected me one jot!”, is very much premature.”
Again it shows your ignorance. I have been a chiro for 20 years. I see at least 1 new patient a day, 3 on thurs. 90+% come from word of mouth. They don’t attend because I’m a chiropractor, I could call myself anything and it wouldn’t affect my business. In the real world with real people with real problems, away from your NHS salary, research grant and statistics, patient outcomes are what matters. FULL STOP. Thats why chiropractors still use chiropractic, thats why osteopaths still use osteopathy, and thats why physios still use traction and Mckenzie.
The day you actually get yourself some clinical experience and get judged by your outcomes, instead of hiding behind and totally relying on your Ebm (whatever that actually is) is the day I will value your opinion. Not that your bothered mind.
Finn
July 24, 2010
Fed Up,
Godwin’s law, you will notice, does not question the validly of the comparison, only that it describes a commonly used analogy. You are offering another red herring. If you refuse to accept the analogy, then that is another example of your denial. My point was that “historical roots” depend on what the history was and how the group (in this case) chose to EVOLVE PAST this history. My point remains however, that chiro, as a profession, has not done the research on the efficacy of its claimed treatments. As well, in not doing this high quality research, it has not established a principled basis upon which it can call itself a science-based health profession.
When you use “So the profession as a whole cannot be blamed” in denying the profession of chiropractic, how do you get around the fact that chiro colleges teach their students concepts which are ludicrous and have absolutely no basis in science? Tell me that that it is untrue that concepts such as “vitalism”, “innate intelligence” and “vertebral subluxation”, and others like them, have been struck down by chiro associations and the educational institutions that train chiros.
You claim, “Again, I’ll draw you back the lack of progress in my profession. This shows chiropractic has changed”. OMG Fed Up, you offer me a link to a textbook as evidence that the profession is!?? Are you on frigging drugs man???? First off, unless a textbook was written by GOD Himself, no one would ever accept that as evidence of anything. Secondly, and this is really my point, that neither you, nor the vast majority of your peer, know ANYTHING about research. Offering this textbook (I still can’t believe you are using this as “evidence” of progress) instead of meaningful citations of high quality research studies that demonstrate the efficacy of chiropractic treatment, is simply unacceptable. This is EXACTLY THE POINT.
Your profession cannot demonstrate that it can do high quality research, that it wants to do this research, that it believes in the value of doing this research, that it is willing to ADEQUATELY train its students to do this research, but mostly, that it is willing to self-reflect, based on the findings of that research. Unless chiro accepts research whole-heartedly, then it simply will not evolve, and it will remain shackled to its HISTORICAL ROOTS. This is the argument.
I notice that you scrubbed the Internet looking for nuggets to support you argument (you are getting to be funny) and found a “forum”, and “traction” was being discussed. While I have no problem with forums per se (obviously), I would not use what someone says in such a casual forum (as if it is moderated in anyway by a professional PT body, etc.) to reflect a profession at large. As I have previously stated several times (PLEASE READ MY WORDS), traction is NOT taught in PT schools as an endorsed modality because it is simply not effective in treating LBP, hence my comment about the myriad of chiros slogging Axial Decompression (aka “traction”) on YouTube. But, further, I cannot do much about some unverifiable post from PAKISTAN who is talking about traction. Again, you demonstrate that you do not use high quality evidence to support your claims.
Here is something that you should use, or similar systematic literature reviews that are of equally high quality. http://www2.cochrane.org/reviews/en/ab003010.html
If you wish to claim that physiotherapy is “bogus” then please feel free to make the claim. Of course some of the older PTs should retire and take their torture-chamber techniques with them to wherever retired PTs finally dock. And of course not all clinical behaviour rests on irrefutable evidence, but, I would say that there is an enormous push on to do the research in PT and bring it into the clinical realm. No, the job is never done, as long as it is started.
But as I have said numerous times, this discussion has nothing to do with physiotherapy except that you keep using it to distract the discussion to. But hey, fill your boots if you need a smoke-screen. It’s called DENIAL.
If nothing, you are the King of Denial.
As for your second post, again, why do you continue to personalize this discussion when it is not about you, or me? It is about the profession of chiropractic and how it promotes itself without evidence for what it claims. It is about selling people on repeat visits for the reason of “maintenance”, a term used by the chiro associations as they teach their members how to build a successful practice. As if there is some risk of losing the ‘magic’ if the patient/client does not continue coming to the chiro. And when there is no physiological basis for the profession, but instead, pseudo-scientific gobbledy-gook terms involving ephemeral mysticism, anyone with a science background questions the validity, credibility and ethics of the chiro profession. If you choose to deny that how one’s profession is viewed will always have an effect on the practicianer, then you are either living in a bubble, or you just don’t care, or both. In any event, you demonstrate that you (like your profession) are isolated from the scientific world and such refusal to self-examine and be part of the mainstream serves no one.
QUACKERY
fed up
July 24, 2010
Finn I have looked at quite a lot of research recently. maybe you should use.
http://www.pedro.org.au/ have a look at all the chiro research on that. It’s by physios for physios.
finn you suggest chiro has not changed. i show you evidence that it has and is changing. you coose to ignore it. You say physio is now only based on EBM and physios don’t use certain methods. I show you evidence that your soiciety does not restrict practice to EBM and that lots of physios use techs that evidence does not support. you choose to ignore it.
“Of course some of the older PTs should retire and take their torture-chamber techniques with them to wherever retired PTs finally dock.” I’m sorry but I must swear. You arrogant wanker. Your proffesion has been constructed and has become a popular and trusted proffesion because of these “older PTs”. where do you think you would be without them?
Finn you obviously don’t work with people, as it’s said. those that can do, those that can’t, teach and those that can’t teach, research. I will bet £1000 , skeptic u can hold me to this, that I will have better patient outcomes than you with your EBm with ANY musculo skeletal problems you care to name. It can be 1 or 50 patients with similar problems, lets see if you have the knowledge to back up your talk. lets have some proper research and see if you can get better results than quackery.
Hildegard
July 24, 2010
Dear Chiropractors near & far, troll Fed Up in particular*;
As an orthopaedics patient who finds it quicker to list the bones she *hasn’t* broken & whose spinal & soft-tissue injuries could fill a page, it really does matter to me what you’re called; it matters how you’re trained, & it matters enormously that you have a solid evidence-base for what you’re doing. All those things come under one simple heading – “patient safety”. If you’re not prepared to keep that foremost in your minds, you ought not to be involved in healthcare on any terms, however alternative.
Without all that, no chiropractor has a better claim to professional status than has a wart charmer.
Relying on anecdotes, testimonials, shoddy research & amour-propre is not enough. Putting your fingers in your ears & singing “lalala” everytime anyone explains placebo & regression to the mean is not enough. Bombast for your critics & a warm cuddly bedside manner for your customers is not enough. In fact you especially, Fed Up, know fine well that none of it’s enough, having been told exactly why it’s not enough so very often & in so very many fora. People have researched the kind of resistance to learning that you display – it’s called “superiority bias”.
Unless & until you are prepared to get a little humility & a lot of scientific knowledge, you back crackers shouldn’t be going within a country mile of our spines.
*(with apologies to AA Milne for abuse of “King John’s Christmas”)
Hildegard
July 24, 2010
Typo alert – 2nd para should read; “without that” not, “without all that”.
Apologies, this is a very brief break from libel reform.
Finn
July 24, 2010
Fed Up,
How can you claim that chiro has changed, when you cannot provide the high quality research that supports this claim? This entire thread is based upon the unsupported claims made of chiros regarding efficacy of treatment and here you are not only refusing to acknowledge this, but then you extend this same lack of evidence, to make the claim that chiro has progressed. Once again, I ask you to provide the evidence for this claim. Claims are simply not enough. Where is that evidence? You make a fool of yourself by providing links, for example, to a textbook on Google books. Are you serious? I mean, is that the best thing that you can find ? Is that how you search the research literature…via Google?
You continue to dance around and never really speak to the issue–that is, the profession of chiropractic is so poorly adept in research methodology and philosophy that it is simply unable to provide a principled basis for the profession. This refusal to support a high quality research agenda makes your profession a laughing stock in the scientific community. How many of your colleagues present findings at neuroscience conferences that are attended by professional scientists? How many of your colleagues publish their research in peer-reviewed journals?
So, once again, I ask you to provide the evidence, by specific reference to citations published in peer-reviewed journals that offer evidence of the efficacy of the claims made by chiropractors. Given that we can find agreement that lumbar manips can be useful in specific cases of acute LBP, it might be more constructive not to argue this point, but perhaps, to extend into other conditions. However, if you wish to, please feel free to provide the evidence that supports repeat visits for “maintenance”, regardless of condition. Kindly provide these citations in searchable format (e.g. PMID no., or author/year/title/journal). Please if you don’t mind, can you also provide the citation to the source that provides the physiological basis for “vitalism”, “innate intelligence” and “vertebral subluxation”, as these terms have been used, and are continued to be used, as the basis for how chiropractic works on the human organism.
I look forward to some interesting reads.
Finn
July 24, 2010
Quackery with a capital “QUACK”.
fed up
July 24, 2010
lol. where are u finn? I’d love to meet up. give me a rough idea, county etc.
bit drunk will reply later.X
Finn
July 24, 2010
Fed Up,
By the way, in mentioning BCA v. Singh, I pointed out that the British Chiropractic Association was only able to come up with 29 studies to support its assertion that spinal manipulation is effective in treating children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, to name a few. You seem to think that because this issue was about pediatrics and you do not treat this population, then this is not an issue. I beg to differ. Given that of these 29 studies, so few were even acceptable, relates to the credibility of the chiropractic profession (in this case, the BCA) insofar as it is honest and trustworthy (and capable of supporting a profession with scientific evidence for the claims it makes). The BCA was only trying to bully Singh. When Singh didn’t blink, their bluff was up, and they got caught and burned for their arrogance. Of course they knew that they were on thin ice, but bet that they wouldn’t have to show their cards.
Claims made by chiros regarding pediatrics was simply the tip of the iceberg. For you to try to spin this as being only about pediatric care is ridiculous. It is far beyond the claims of chiros as they pertain to this population/condition. The same lack of evidence exists for many other areas that chiros claim to treat efficaciously.
You yourself have referred to Sackett previously, although I don’t think you have the faintest idea of what he is referring to given your utter lack of research savvy. In fact, Sackett, et al (1996) provided criterion for what constitutes evidence (read EBP), “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence”. Best evidence is what is available; it does not mean or imply that somehow the clinician is denied or discouraged from using clinical experience in his judgement, but that research must be conducted in order to produce an evidence base and be used as guidance. Chiropractic simply does not accept this approach at all. You scoff at EBP, you obviously know nothing of research, and you certainly are totally incapable of not only searching the appropriate databases for research studies, but also of critically appraising such literature once it is in front of you. In this way, you are no different than any chiro., regardless of what you claim to do or not, as a clinician.
Quackery quacks…
Finn
July 24, 2010
Fed Up,
Here is a good place for you to start your journey from the fringe into the 21st Century world of science, where we in health care use research to gather the best evidence available and guide clinical decision-making.
How to critically appraise an article (Jane M Young and Michael J Solomon). http://www.nature.com/nrgastro/journal/v6/n2/full/ncpgasthep1331.html? (How to evaluate study design and assess methodology – tells you the key points to consider when reading an article.)
Evidence-Based Medicine – what it is and what it isn’t (David L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott Richardson) http://www.bmj.com/cgi/content/full/312/7023/71 (It’s about integrating individual clinical expertise and the best external evidence – e.g., systematic reviews.)
Trick or Treatment (Edzard Ernst and Simon Singh) http://www.amazon.co.uk/Trick-Treatment-Alternative-Medicine-Trial/dp/0593061292/ (You may be familiar with this book, if not, you should focus your attention to the chapter on chiropractic in particular.)
Finn
July 25, 2010
Fed Up,
Continued from Sackett et al (1996):
(p. 71):
“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
Do you read in here anything that say the clinician should not use clinical experience to treat individual patients? NO.
(p. 71):
“External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.”
If the chiropractic profession refuses to engage in research and will not accept Evidence-based Practice as a means of moving its practice forward, then by what method is it using to do so? How does the profession of chiropractic meet its responsibility to the public by assuring that what it claims to treat is based on science and that it is efficacious in those claims?