Respectful Insolence

Is chiropractic woo?

I’m often asked that question, and my answer has usually been something along the lines of, “It depends on what it is used for.” Of course, there’s no doubt that the “theory” behind chiropractic, namely that so-called “subluxations” of the spine are the source of nearly all disease, is a load of the purest woo. After all, going back to the origin of chiropractic in 1895, you will recall that Daniel David Palmer essentially made up chiropractic out of whole cloth when he claimed to have restored the hearing of a deaf janitor by “adjusting” a bump on his spine. As a result of this, he concluded that “subluxations” somehow mess up the body’s expression of “innate intelligence.” When you come right down to it, though, “innate intelligence” comes off sounding very much like the Eastern concept of qi, or life energy, and adjustments of “subluxations,” in concept relative to qi, are not unlike acupuncture in that chiropractors claim that “adjusting” these subluxations release “nerve interference” and thus cure disease caused by this interference, much as acupuncturists claim to “unblock” the flow of qi.

Consequently, my answer to the question of whether or not chiropractic is woo is multifaceted. The theory of chiropractic is, without a doubt, pure woo, but many modern day chiropractors try to downplay the woo part and “mix” with modern medicine. Chiropractic might have value in back pain and other spinal problems, but, if it does, it is the same sort of value that a good physical therapist provides with physical manipulation of the spine, which is why I have sometimes referred to chirpractors as physical therapists with delusions of grandeur. (In fact, for back pain I’d far rather have a good physical therapist than a chiropractor.) A man’s got to know his limitations, and many chiropractors don’t know theirs, claiming to treat asthma, sinus diseases, diabetes, infectious diseases, and infant colic. Indeed, criticizing chiropractors for claiming to be able to treat infant colic when there is no valid scientific evidence to support such a claim is what got Simon Singh into trouble when the British Chiropractic Association sued for libel. In any case, apparently there is almost nothing chirpractors can’t treat, at least if you believe their claims.

They also seem to think that they know how to treat pregnant women during labor:

Post doctoral research fellow at the New Zealand College of Chiropractic, Dr. Jenny Kruger and Research Director, Dr. Heidi Haavik-Taylor, have commenced research into how chiropractic care can make giving birth an easier, safer experience for pregnant women.

The study, launched last month, will specifically look at how chiropractic care may influence pelvic floor muscle function in healthy women, before and after childbirth, and in women suffering from pelvic floor dysfunction.

‘We are working with a number of pregnant women here in New Zealand and the University of Australia in Sydney, which is also involved in the study, is testing hundreds, of woman’ explains Dr. Kruger. ‘We are using state of the art, 4D ultrasound to visualise the pelvic floor of women, pre and post chiropractic adjustments. We want to see whether spinal adjustments can alter the way the pelvic floor works.’

‘We are learning more and more as we go along,’ adds Dr. Kruger. ‘Our ultimate aim is to reduce the number of women suffering from prolapse after giving birth. We would like to be able to identify those that are at a greater risk before they even go into labour. That way, their health professionals can work with them before birth and take special precautions once they are in hospital, to give them the best chance of having a safe, trouble free birth.’

This is exactly what I mean by quackademic medicine. Here we have all the trappings of scientific medicine and actual clinical research in the form of ultrasounds and an apparent clinical trial. We have a university, the “University of Australia in Sydney,” which my Australian friends tell me doesn’t exist. (Maybe they meant the University of Sydney.) Unfortunately, all this “science-y-ness” is yoked to the neck of an incredibly implausible hypothesis, namely that spinal “adjustment” would somehow prevent uterine prolapse or can somehow make a trouble-free birth more likely. What is the preclinical evidence that justifies such a trial? Who knows? Certainly it isn’t studies like this one, which claims a benefit but has no control group and wasn’t randomized. Even systematic reviews of chiropractic performed by chiropractors and published in the “alternative medicine” literature don’t show any real evidence of benefit that can be distinguished from the placebo effect or the natural history of the clinical problem. Certainly the press release announcing the study doesn’t show any convincing evidence to justify this trial.

There is, however, throughout the Internet on chiropractic websites, a whole lot of woo claiming that chiropractic is very useful for pregnancy. For instance, a chiropractor named Martha Collins opines:

Chiropractic care through pregnancy is not only safe, it is essential. We can look at the implications of subluxation from a bio mechanical, hormonal and neurological standpoint. It is easy for all of us to see postural changes through pregnancy-the centre of gravity changes, the weight of the baby places increased pressure on the spine and pelvis, and towards the end of the pregnancy, changes are seen in gait pattern-the “waddle.” What we can’t see, are the millions of different hormonal changes and chemical reactions occurring both in the mother and the developing baby–all of which are controlled and coordinated through the nervous system.

But it’s not just the mothers who need chiropractic, don’t you know? It’s the babies as well:

When we listen to mothers’ stories of their pregnancy, labor and delivery, the children who suffer the most from the above complaints, are the ones who’ve had the greatest trouble with their births. Even relatively easy deliveries can result in subluxations. That’s why every child should be checked, before problems with their health even develop. That’s preventive care in the truest sense-preventing subluxations in mothers to prevent subluxations in their babies during childbirth. This is why every woman needs Chiropractic through pregnancy-so that the arrival of their baby is a “wonderful experience”, as one of my patients told me last week, after her son was born.

Even if it’s possible to justify the use of chiropractic as a form of glorified physical therapy for patients with back pain, it’s not possible to justify the chirpractic adjustment of babies using any decent scientific and clinical studies. The ideas used to justify using chiropractic on pregnant women derive from the nonsensical concept that vertebral subluxations can cause poor function of the uterus by somehow putting pressure on spinal nerves. This concept leads to the claims of chiropractors that:

  • Failure to prevent sacral and pelvic subluxations can result in abnormal positioning of the baby in the uterus.
  • Babies can be turned from a breech position to a normal vertex (head down) position simply by adjusting the sacrum.

If you want to get an idea of the degree of self-delusion going on here, look at the Bagnell technique, which appears to be similar to the Webster technique. Using this technique, chiropractors claim to be able to reverse a baby in breech presentation. No success rate is given other than to say that “often, within 48 hours of the first adjustment to the mother’s spine and pelvis. Without any sort of controlled trials, it’s impossible to know whether chiropractic manipulation had any effect whatsoever or whether these were simply spontaneous versions out of breech. In another article, two chiropractors claim to have a 95% success rate. If this were true, you’d think they could verify this number with some actual data, wouldn’t you? At least, I would. Given that most breech presentations early in term resolve spontaneously, unless these chiropractors can show that they have a 95% success rate at 39 or 40 weeks, the far more plausible explanation is that the chiropractic manipulations had no effect.

Once again, we see alt-med promoters putting the cart before the horse. Chiropractors have an incredibly unlikely hypothesis, without any good clinical data to sugest that chiropractic can reverse breech presentation other than the claims of some chiropractors that they have a 95% success rate, with no evidence to document such a fantastic claim. They think that preventing fantastical subluxations in the mother prevents them in the baby and that babies born with these magical disorders require–of course!–chiropractic adjustment. In the meantime, in New Zealand, chiropractors are subjecting pregnant women to what is almost certainly a useless procedure and even studying it in a clinical trial.

Quackademic medicine marches on.

Comments

  1. #1 Pablo
    April 9, 2010

    Who the hell puts out a press release announcing you are doing a study? Don’t you announce results? Putting your statement out frst really compromises your objectivity, especially when it speaks as if you are studying a real effect, as opposed to whether looking to see if there is an effect in the first place.

  2. #2 Todd W.
    April 9, 2010

    I’d like to see the materials that were submitted to the IRB that approved this study.

  3. #3 Bill
    April 9, 2010

    Confirm no University of Australia. Closest is the Australian National University here in Canberra.

    Agree with Pablo – a press release announcing your study and, pretty much, your results???? Really setting the bar high for themselves – but of course, with their protocols, I have no doubt this study will be a ‘raging success’!

  4. #4 christophe-thill.myopenid.com
    April 9, 2010

    “We are using state of the art, 4D ultrasound to visualise the pelvic floor of women”

    However hi-tech, it sounds a bit kinky…

  5. #5 Dangerous Bacon
    April 9, 2010

    “Who the hell puts out a press release announcing you are doing a study? “

    That isn’t so unusual. The tone of this release suggests, however, that the outcome is already known (in favor of chiros) and that they will be using high-techy gadgetry to prove it.

    “Post doctoral research fellow at the New Zealand College of Chiropractic, Dr. Jenny Kruger and Research Director, Dr. Heidi Haavik-Taylor, have commenced research into how chiropractic care can make giving birth an easier, safer experience for pregnant women.”

    I’ll be interested to see how they prove that chiro adjustments reverse subluxations to improve pelvic floor musculature, when no modality has been able to demonstrate that such subluxations exist in the first place.

    It would help though if they could find a real university to do the work in.

  6. #6 Calli Arcale
    April 9, 2010

    There are documented cases of paralyzed women, comatose women, and even one recent case I know of involving brain death having successful pregnancies resulting in normal children; odd, that, if preventing subluxations is critical to proper function of the uterus and regulation of hormones critical to development. I wonder what these chiropractors make of such things, since they contradict their predictions?

  7. #7 Todd W.
    April 9, 2010

    @Calli Arcale

    Clearly, those are just outliers. Weird flukes.

  8. #8 SirLoins
    April 9, 2010

    Christine Kent who wrote that “Saving the Whole Woman” book on how proper posture can prevent and treat pelvic prolapse will love this.

  9. #9 Elf M. Sternberg
    April 9, 2010

    One day when I was giving my daughter and her friend a lift to the mall, I picked up the friend at her mother’s office– a chiro. There was a piece of theater there that I found most impressive.

    The “Doctor’s personal office” was at the end of a long hall that stretched down from reception. It was a well-appointed room with plush carpeting, a broad oak desk, dark wooden bookshelves elegantly filled with official-looking journals, and many many award certificates on the wall. On the wall present just where the door was opened, and so clearly visible to anyone who walked down the hall, was a four-foot high poster of a spine, with the words “THE DEADLY KILLER: SUBLUXATIONS” on top, and below, “The root of most illness and death.”

    The woo, truly, was strong with that one. They looked mostly like a glorified physical therapists-cum-therapeutic massage shop, but along with the physical therapy they also sold herbs, vitamins, and the wooiest of colon blows.

  10. #10 Ian
    April 9, 2010

    4D? What exactly is the 4th D? A tesseract? Perhaps smell?

    If it’s “time”, then isn’t EVERY ultrasound at least 3D? If I make a flat movie that happens over time, does that automatically make it 3D?

  11. #11 Sir Eccles
    April 9, 2010

    Old fashioned ultrasound is usually just a slice through. 4D ultrasound provides those cool 3D renderings of the baby in the womb. As I understand it there is some concern that the higher energy needed to produce these images has the potential to be harmful. There is some discussion of medically unnecessary ultrasound that seems to focus on these 4D techniques.

  12. #12 Scott Cunningham
    April 9, 2010

    I don’t think the researchers will have any trouble conducting their experiments without a real university (supposing for the moment this isn’t a mistake.) After all, chiropractic’s survived this long without any clinical evidence or even a plausible explanation. And then there’s the common claims that “millions of people benefit” without having any statistics, and sometimes, not even a testimonial. Heck, this study could probably proceed just fine with an n value of zero. All that really matters is that the faithful see another promise of future vindication to reinforce their irrational belief.

  13. #13 Pablo
    April 9, 2010

    Is it worth the effort of contacting every publication that you see that picks this story up and asking them to verify the existence of the “University of Australia in Sydney”?

    Scott, it’s not about whether the research is associated with a university, but the fact that they actually invented, apparently, a university to associate it with!

    I’d love to hear the editor’s response.

  14. #14 Jules
    April 9, 2010

    I think further research needs to be done into Chiropractic for turning breech babies.

    My daughter was breech at 36 weeks, and a friend suggested I have an adjustment. The mere suggestion was enough to flip the baby.

    So, where can I get some of that sweet research cash?

  15. #15 Pareidolius
    April 9, 2010

    Do they really call it 4D? That’s so science fiction-y. But then again, so is their university.

  16. #16 MikeMa
    April 9, 2010

    My daughter in law had one of those 4D ultrasounds. Very cool technology. You basically get a movie of the baby moving around. We saw the baby licking and speculated on what mom had eaten recently. They also had a doppler thing with it which showed blood flow in the heart and fluid flow in & out of the baby’s mouth.

    This particular place also had an internet hookup to allow dads stationed overseas to see the video images.

    As for the chiro crappola, it must be associated with the “University of Making Shit Up”. They do all that woo research.

  17. #17 Ian
    April 9, 2010

    4D ultrasound provides those cool 3D renderings of the baby in the womb.

    I’m sorry, maybe I lost count, but how is a 3D rendering of a fetus 4D? What’s D #4? I’m not picking on your description of it; I’m picking on calling it “4D”. It’s a stupid name.

  18. #18 Anthro
    April 9, 2010

    @#9, Elf

    I had a similar experience when a chiropractor came into my little store and proceeded to tell me she was a “doctor” (as are all my friends with PhD’s in various fields) and kept answering her pager and flapping around as though she were very important. I asked her what clinic she was affiliated with and she proclaimed that she was a chiro. Then she claimed she had to leave for an “emergency”. Good riddance I thought.

    Why don’t these people get real medical training if they want to “heal”? I don’t think physical therapy training is much longer than chiro school–or nursing, or respiratory tech and so on. If they just want their own business, they could do massage–although most of the ones I’ve tried lately are liberally dispensing “medical” advice as well. I despair!

  19. #19 Todd W.
    April 9, 2010

    The 4D thing kept niggling at me, too. I understood that they were trying to say that they included time in the image (i.e., motion picture), but the first thing that popped into my mind was, “Oh, they give you some 3-D glasses to watch it?”

  20. #20 Sastra
    April 9, 2010

    In another article, two chiropractors claim to have a 95% success rate. If this were true, you’d think they could verify this number with some actual data, wouldn’t you? At least, I would.

    And this common situation is one that makes me wonder if, deep down in their heart of hearts, people who promote pseudoscience know that they’re really just playing an elaborate game of let’s-pretend with themselves, other people, and the world. Psychic powers, dowsing rods, some form of alt med — we keep seeing these extraordinary claims for strong, clear, regular results, reproducible on demand. 80%, 90%, even 100%. They see it work “all the time.” They’re completely confident.

    And yet, bring up controlled, scientific testing, and suddenly they get all huffy, or cagey. They have “nothing to prove.” Or they’re too busy helping people one-on-one to bother with increasing the sum knowledge and well-being of humanity. Or it’s “being done.” Or it’s already “been done.” Or they’re just offering their own experience, and don’t want to force their truths on others.

    Or, in some cases, the demand for objective evidence is seen as a sign that the person making that demand isn’t yet ready to accept it, because they have a negative personality, and they need to work on that, first. No evidence would be enough for them, so why bother? All the really cool people, are comfortable and open to truth.

    I think that, when people are serious about what they do, make, create, or invent — and think it is an improvement over everything else — they are usually wild to test it. Official tests, the more objective the better. They don’t suddenly go all coy and modest, or wax indignant over the implied insult. At some level, pseudoscientists must know this.

  21. #21 Ewan R
    April 9, 2010

    Ian – agreed, silly name, however that does appear to be standard (in my limited experience) for the new(er?) method of ’3-D’ ultrasound movies (as offered at your local baby dispensary).

  22. #22 Pablo
    April 9, 2010

    As one with relatively recent experience with advanced dimensional ultrasound imaging, and soon to have more (in another month or so), I can aver that the 3D and 4D labels are bandied about pretty much interchangeably.

    Non-advanced dimension ultrasound is just called “ultrasound.”

  23. #23 Pablo
    April 9, 2010

    I think all the OBs would love to find an approach that is 95% effective in turning breech babies. Amazingly, when we hit 34 weeks and the Gurg was still sitting head up, the number the OB quoted to us was maybe 30% effectiveness overall, although first pregnancies that they try to turn end up at more of the 10% effectiveness range. The partner that we visited at one of our appointments tried chanting (“turn, baby, turn…”) while moving his hand in circular motions over mom’s belly, but that was not successful, either.

    (btw, he was joking)

    The Gurg never did turn (we didn’t even bother manipulation), and ended up coming by c-section.

  24. #24 Corina Becker
    April 9, 2010

    Probably heard something similar to this:

    I had a chiropractor claim that most people had underlying back and spine problems from birth because doctors twists the head and neck during delivery. So all healthy hospital births were damaging.
    He then claimed that because his children had been adjusted every week since birth, that they did not get sick or have allergies. He also claimed to be able to reverse asthma, diabetes and other medical illnesses, not to mention relieve migraines. He even claimed to be responsible for an ADHD kid’s development to be able to settle down and sit still for a while.
    Later on, myself and a friend mentioned that her little sister and myself are autistic, and he claimed that he has had great success with autistic children. He mentioned a boy who, in the course of a few months, went from drawing stick figures to 3D drawings. He claimed that it was because of his adjustments that the boy was “relating to the world” better.

    And of course, he gave us a rant about how medications are the bane of health today. The stuff that saves lives and keep people alive, those were good, but the ones for everything else = BIG PHARMA.

    I picked up some of the brochures in the waiting room; they were from Koren Publishing, and quoted Chopra’s Quantum Healing, really old studies and newsletters. I was not impressed. But it was also kinda entertaining.

  25. #25 Calli Arcale
    April 9, 2010

    Pablo @ 23:
    Turning a baby is risky, but so is breech birth — I luckily didn’t have to decide, since my first baby turned a few weeks before delivery, and my second baby was finally head-down at my last prenatal checkup. Alas, she didn’t stay that way — she was breech again by the time I went into labor. (Induced by her; she kicked very hard, and the membranes broke. She was born with unusually strong and sharp toenails, which may have been a factor, and was unusually strong at birth, holding her head up only an hour after birth when most babies don’t manage that for weeks. I seem to have given birth to She-Ra….) That’s part of the trouble with turning babies, of course; they might turn themselves right back again. And a wussy little spinal manipulation ain’t gonna do a thing. I know people who’ve had their babies turned. It’s pretty painful.

    Corina Becker @ 24:

    I had a chiropractor claim that most people had underlying back and spine problems from birth because doctors twists the head and neck during delivery. So all healthy hospital births were damaging.

    Irony of that, of course, is that the head and neck *have* to turn if there is to be any hope of getting out of the birth canal. And if all goes well, this will happen regardless of whether not there is a doctor present. It happens in women who give birth completely alone; it’s a fact of anatomy.

    I read about a professor of obstetrics who had a female skeleton in his (or was it her?) office, and the skull of a full-term fetus. (May have been reproductions; I don’t know.) This professor liked to give students the skull and then figure out how to get it through the pelvis of the skeleton. It’s harder than it looks, even without all those muscles and things to deal with, and several turns are required for even the ideal presentation.

  26. #26 Liz Ditz
    April 9, 2010

    The chiros start their own journals to publish “research” (single-subject case studies, usually) and then promote the bejeezly out of said “research”. (See the Journal of Subluxation Research, and also do a search for “chiropractic” AND “Matthew McCoy” — add terms to your liking, such as ADHD and you’ll see what I mean.)

    Chiros also seem to like to make up their own terms such as functional disconnection syndrome and developmental delay syndrome (both links take you to John Wills Lloyd’s blog, analyzing “research” done by chiros.)

    Sigh. So many, many quack treatments on offer….

  27. #27 jane
    April 9, 2010

    Several years ago, NEJM published a study showing that moxibustion (in this case, burning the herbal mixture on the little toe) dramatically improved the odds that a fetus would turn. I would have bet good money in advance that that wouldn’t have worked, and I can’t imagine how it works, but the numbers were impressive enough that if I were approaching a compulsory C-section for breech birth – which is the essential situation in many American hospitals – I’d sure give it a try.

  28. #28 Grant
    April 9, 2010

    I wonder if this is a case of trying to steal credit. Dr. Kruger’s study is given on a University of Auckland news page with no mention of it “specifically look[ing] at how chiropractic care”:

    http://www.abi.auckland.ac.nz/uoa/home/news/template/news_item.jsp?cid=252834

    I hope to look into this a little more and present a post about it later this weekend. My main question is why specifically chiropractic? (After all in principle they would have turned to conventional physical therapists.) The modelling work, however, is based in a very reputable modelling institute. (Bio-mechanical modelling is that phrase that comes to mind.)

    On other note, I have previously written about a local chiropractor who has a tendency to make silly claims in his advertising.

  29. #29 Grant
    April 9, 2010

    Damn, I meant to delete the first sentence. Please disregard it. My apologies, that sentence really is not meant to me there.

    I do think there may be more to this than the press release indicates however.

    Anyone can write a press release and send it to scoop.co.nz, in fact articles from our blogs are automatically feed there (organised by the powers-that-be that run our blog collective).

  30. #30 MikeMa
    April 9, 2010

    My daughter in law had one of those 4D ultrasounds. Very cool technology. You basically get a movie of the baby moving around. We saw the baby licking and speculated on what mom had eaten recently. They also had a doppler thing with it which showed blood flow in the heart and fluid flow in & out of the baby’s mouth.

    This particular place also had an internet hookup to allow dads stationed overseas to see the video images.

    As for the chiro crappola, it must be associated with the university of making shit up. They do all that woo research.

  31. #31 DLC
    April 9, 2010

    I wonder if I could get an NCCAM grant to study the effects of Homeopathy on dehydration ?

  32. #32 Leigh
    April 9, 2010

    Well, I think I’m going to be the one dissenting voice amoung all commenters.
    I am a birth doula and have witnessed 71 births. Most of them have been natural, some born at home, some in the hospital. I work closely with midwives, chiropractors, acupuncturists, and naturopaths.
    While I haven’t kept “data”, I can attest first hand to the positive effects of Chiro care both on a pregnancy and on promoting a smoother, more efficient birth. For my clients who seek continual Chiro care with a Chiro TRAINED in Webster (pregnancy) technique, I am continually amazed at how shorter and smoother their births are. These women also have many less pregnancy discomforts, such as lower back pain and sleeping issues.
    I am also pregnant with my third baby and have received Chiro care with two. With this pregnancy, I have weekly Chiro care and have never felt better. I have had none of the usual hip/joint soreness from sleeping on one side like I usually do – UNLESS I miss a week of Chiro care. Want to know something else? In my last pregnancy, I was skeptical of Chiro care. I told the Chiro, “This is probably silly, but I have hemmorhoids so I don’t know if you can help that”. She said “Of course I can”. And can I tell you that for the first time in over 10 years, my hemmorhoids were reduced???
    Now, all my my babies have been breech. My two didn’t turn and I don’t think this one will. I birthed #2 at home, naturally and plan on doing that with this one. Nothing I did – slantboard, exercises, Moxabustion, Chiro, Acupucnture – turned my babies. I believe my pelvis is shaped as such to carry breech babies. BUT, I have indeed seen a high success rate with turning breech babies and Chiro care (yes, late term babies).
    Again, I don’t have data, but please also trust someone who has alot of first hand knowledge of working with pregnant women. The difference is amazing.

  33. #33 Militant Agnostic
    April 9, 2010

    Again, I don’t have data, but please also trust someone who has a lot of first hand knowledge of working with pregnant women. The difference is amazing.

    In other words, I have no data but you should trust my selective memory and confirmation bias.

  34. #34 Glyph
    April 9, 2010

    the 4d ultrasound refers to them also following along in the time dimension (as if normal ultrasounds didnt have a time component.)

    This is a new thing and a good cash business mainly employed for prenatal imaging for people who want fancier pictures of their babies. Its totally medically unnecessary if the person has already had a 2nd or 3rd trimester ultrasound to evaluate fetal anatomy.

    Here is a copypaste from a website prenatalpeek.com

    4D” is shorthand for four-dimensional – the fourth dimension being time. As far as prenatal ultrasound is concerned, 4D ultrasound is the latest prenatal ultrasound technology. 4D takes three-dimensional 3D ultrasound images and adds the element of time to the process. This allows you to see your unborn baby in amazing real time detail

  35. #35 redrabbitslife
    April 9, 2010

    Oh goody, a professional handholder opines.

    71 births: half a week of obstetric training. Indeed, that’s TONS of experience.

    Most babies indeed do turn on their own, so I have little doubt that the chiros “get great results.” I could get the same amazing results by ignoring my patients, by painting their toenails, or by getting them a glass of water. And I have as much evidence for that as you have for your chiropractors, NAY more. Not particularly convincing? No, but neither is hot air, which is all I’m hearing.

    I mean, I could say: women trained in the techniques of self effacement in the Mennonite and other religious communities have much smoother, less eventful births, and that I am constantly amazed by their stoicism. To an extent, that would be true, but only because I have never met a drama queen out of those communities. In other words, your observations about a self-selected group of people, not so useful in making predictions about the population as a whole.

    I wish you luck with your home birth. I think it’s a bad idea, but you’ll likely be lucky, and I really hope so.

  36. #36 Jimbo Jones
    April 10, 2010

    Re: 4D ultrasound
    The fourth dimension is spatial in this case. Time was already included in the original 3 dimensions. The “normal” ultrasound has two spatial dimensions and a time dimension. 4D ultrasounds add another spatial dimension, such that you can look at the scanned object (in this case, a fetus) from any angle. It’s the same difference as is between a photograph and a hologram. Can we move on?

    Chiros: gods they annoy me. I live in a suburb that seems to have more chiros/osteos/woo-hawking bastards than actual medical facilities. Apparently people around here think they’re a whole lot smarter than they are. You know, knowing better than to go see a doctor. Makes me want to scream.

  37. #37 ESPness
    April 10, 2010

    Maybe it’s a kiwi thing to announce your study before you do it. Here is one from North Shore Hospital for using acupuncture in the ED for leg and arm injuries. http://www.waitematadhb.govt.nz/LinkClick.aspx?fileticket=HkOB%2FXWkvT4%3D&tabid=79&mid=969&language=en-US

    I can’t find any results for it though.

  38. #38 Pablo
    April 10, 2010

    Oh, you said “accupuncture IN the ED”. I thought it said “for ED” and going to wonder how that worked.

  39. #39 Corina Becker
    April 10, 2010

    Calli @25

    Yeah, I’ve looked at anatomy. Baby heads are big. Women’s hips and bones and everything else… well, I have big Mennonite hips, supposedly good for farming and having kids. But still, it looks and sounds like a lot of hard work.

    Also, I’m wondering whether this applies to C-section births. According to the chiropractor, it does. He claims that my completely healthy hospital C-section is what caused trauma to the left side of my neck, causing my entire left side to be out of place, making my left leg look shorter and the probable cause of my migraines. He also claimed that any sort of trip or fall can cause damage that can eventually become some sort of spinal degeneration.

    I giggle because the school he went to is on QuackWatch.

  40. #40 Pen
    April 10, 2010

    @25 “I read about a professor of obstetrics who had a female skeleton in his (or was it her?) office, and the skull of a full-term fetus. (May have been reproductions; I don’t know.) This professor liked to give students the skull and then figure out how to get it through the pelvis of the skeleton. It’s harder than it looks, even without all those muscles and things to deal with, and several turns are required for even the ideal presentation.”

    That professor was stringing the students along as well, though. I hope he also taught them about the flexibility of the pelvic bones at birth, and especially the bones in the infant’s skull. If you’ve seen a newborn, they are all pointy headed, which is also normal and part of the birth process. Dead or plastic skeletons don’t do that.

  41. #41 dizi izle
    April 10, 2010

    Damn, I meant to delete the first sentence. Please disregard it. My apologies, that sentence really is not meant to me there

  42. #42 yogi-one
    April 10, 2010

    Is chiropractic woo?

    I think not in and of itself. I use it because I, like my mother, and her father before her, was plagued by migraine headaches. For years I searched for causes, and was given various explanations by friends, doctors, and others. I took a lot of painkillers, and got a tolerance to most of the commercially available ones, and usually they could not overcome the pain anyway.

    Then one day I got a thing in the mail from a local chiro adding in a free x-ray. I thought “free x-ray?” so I did it. The x-rays showed where the vetebrae in my neck had shifted ever so slightly and were pressuring some nerves and causing inflammation.

    Within two weeks of twice-a-week adjustments I cut the frequecy of headaches in half. Now I go about once a month and very rarely have a severe one. In addition to the sessions, the chiropractor taught me the value of sleeping with my head properly positioned and supported for alignement purposes.

    I don’t need a double-bind study. My goddam head stopped hurting. That was the money result for me.

    But claiming that chiropractic can cure diseases when they don’t have the evidence to back it up is, by definition, woo.

    I think spinal alignment is a good overall health benefit.

    Anecdotal evidence and testimonials are great for creating new customers. But scientific evidence is needed for medical claims.

    So I think the consumer has to take the responsibility for figuring these things out. There are honest good chiropractors who won’t lie to you out there, and you can benefit from their sessions. And the ages-old profession of snake-oil salesmanship is quite alive and well in modern times, and really, there’s no way to counter it besides consumers educating themselves before they buy.

    I think the pressure to create new cutomers has probably driven some chiroprators to stretch the truth and claim results that are either non-verifiable, or that they have some anecdotal evidence but insufficient (or no) clinical evidence for.

    So the burden is also on the practitioners to keep high professional ethics and honest business practices.

    Otherwise they run the risk of being lumped in with the tea-leaf readers. I think a good chiroprator who has done the years of schooling and the apprenticeships would appreciate the value of separating his profession out from the tarot-card crowd.

  43. #43 storkdok
    April 10, 2010

    @Leigh

    “I am a birth doula and have witnessed 71 births.”

    Wow, that’s a big number. At least, that’s what I thought on my third day of OB/GYN residency when I surpassed that.

  44. #44 MereMortal
    April 10, 2010

    Hooooooly heck, I didn’t know what I was in for commenting on here. Ha!

    Talk about no respect for other professions. Blows. Me. Away.

    I thought my tone was rather respectful and I guess I expected that back. Anyways….glad I work with OB’s who support doulas. :)

    @storkdok and @ redrabbitslife: 71 births is OF COURSE nothing compared to OB/GYN residency. I never insinuated that. But how many home births have you attended? How many spontaneous, natural births? How many births of women following their own cues, their own bodies, with no augmentation and intervention? Still more than me, of course, but my job isn’t a factory. I’m a one-woman shop, with a laboring woman from the time she calls me until hours after birth. I can’t possibly do that for 71 women in a week.

    I’m not a medical professional. I’m a…”hand holder” (as a commenter mentioned) and damn proud of it. Hand holders like me have the potential to make a huge difference in a women’s birth experience and for that, I need no other validation. http://www.dona.org/resources/research.php#birth

    However, something very critical to note, is that I witness women in spontaneous labor from very early on all the way through postpartum. Meaning, I see the whole spectrum, witness the entire natural process of labor. I don’t show up when she’s pushing or just to catch or to perform a section. Tell me how many OB’s get that experience (and no, inductions do no count)? Not many. And I know that from having personal relationships with OB’s too. So, I do see that as having very valid experience and knowledge with women.

    @ redrabbitslife: thank you for the well-wishes on my birth. It will be homebirth #3 for me and I feel utterly safe and perfect about it all. your bad idea = my dream. :) thank goodness for choice.

    It’s the women in the hospitals who I think need all the luck in the world! So thus, I “hand-hold” them through their experiences, hoping my support gives them comfort and a safe birth.

  45. #45 momkat
    April 10, 2010

    Coccygeal vertebrae are very rigid so I don’t see how chiropractic manipulation of them could make any appreciable difference during the mechanical maneuvers that occur during labor. Flexion, extension and restitution that occur during labor are normal processes that allow for our large heads to get throught our relatively small pelvises. To counter Leigh and her doula (labor coach) experience, I have a conservative estimate of 50 deliveries A YEAR for over 20 years to say MY experience as a labor and delivery nurse contradicts hers. The rare conversion attempt that was even made where I work failed more often than succeeded (same as her, only anecdotal evidence). Babies present the way they do for MANY reasons, so when chiros claim that spinal factors are the root cause of 95% of breech presentations I have to roll my eyes. Until they can present reproducible scientifically relevant studies, they are wishful thinkers (aka “making shit up”).

  46. #46 storkdok
    April 10, 2010

    @MereMortal

    Were you looking for validation of your “professional anecdotes”? This blog has a lot of medical professional readers on a regular basis. You won’t find people here gushing about your misinformation and personal anecdotes. You have no idea how we are trained and how we practice. You have the typical chip on your shoulder that homebirthers have.

    For your baby’s sake, I hope you have no complications. Should you have complications, I hope you are able to get to a hospital quickly. That has not happened in several attempted home births that I became involved in after transport.

  47. #47 Calli Arcale
    April 10, 2010

    Pen @ 39:

    That professor was stringing the students along as well, though. I hope he also taught them about the flexibility of the pelvic bones at birth, and especially the bones in the infant’s skull. If you’ve seen a newborn, they are all pointy headed, which is also normal and part of the birth process. Dead or plastic skeletons don’t do that.

    Yes, this professor did teach the obvious, that babies skulls are not fused, but there is a limit to how much they can compress, and the point of the exercise was to drive home for the students just how much of a contortion the baby has to go through in order to get out. In fact, I seem to recall part of the point was that no student was ever able to actually achieve it, which would presumably drive home the point about a flexible skull. I’ll have to see if I can find the article again. It was actually part of an article on evolution, in either Smithsonian or National Geographic, maybe two years ago.

    MereMortal:
    Kudos to you for helping women have a positive birth experience. I know that for many women, birth is about having an empowering experience, and for them, hand-holding is very important. It wasn’t for me. I’m quite secure in myself. I don’t need someone to empower me. I need experts to assist in the event of disaster, and that is why I chose to give birth in a hospital for both of my babies. For me, the most important element of having a positive birth experience wasn’t whether anyone was holding my hand. For me, being able to go home with a healthy baby was the most important part. And that, for me, is where science-based medicine comes in. I see no science confirming your assertions. Just your “experience”, which you concede you have kept no real records of, and so cannot even validate for your own benefit, much less the benefit of your future patients. The family practice doctor who treated me through my entire pregnancy and then became my baby’s pediatrician has extensive records. She can tell me the exact percentage of her deliveries which have ended up as c-sections. Can you tell me that sort of thing for your clients? If not, how am I to judge your quality? Or the quality of a chiropractor claiming to improve pregnancy outcomes, for that matter?

    You are not disrespected because of your profession. I think doulas provide a very valuable service for many women. However, unsupported assertions will tend to be disrespected around here, as will an appeal to one’s own expertise when that expertise is clearly inadequate. I mean — you’ve followed women from the first labor pains to postpartum? Bully for you — but my doctor followed me from *conception* to . . . well, actually she’s still following my eldest, who is now six. Beat that. ;-)

  48. #48 Jason Brown
    April 11, 2010

    Lots of Chiropractor bashing going on here. Chiropractic works excellent for musculoskeletal injuries. As far as the other diseases…there is no research to prove or disprove. I think the scientific community needs to accept that not everything can be explained. Strange stuff happens with chiropractic care…but strange things also happen in medicine…just accept it.

  49. #49 ESPness
    April 11, 2010

    I think the scientific community needs to accept that not everything can be explained.

    I love this bit the most. So what do we do, give up trying to explain these things or just call it magic?

    Welcome to the middle ages bloke.

  50. #50 Grant
    April 11, 2010

    @47 (Jason Brown):

    As far as the other diseases…there is no research to prove or disprove.

    There is research that shows there is no support for all but one treatment. I would invite you to read Bonfort et al (PDF file):

    http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf

    (My own summary of this paper is linked on my name; drop to the second half of the article if you want to skip the stuff about Simon Singh.)

  51. #51 Pteryxx
    April 11, 2010

    In my last pregnancy, I was skeptical of Chiro care. I told the Chiro, “This is probably silly, but I have hemmorhoids so I don’t know if you can help that”. She said “Of course I can”.

    I don’t need a double-bind study. My goddam head stopped hurting. That was the money result for me.

    But there *is* a scientific explanation for positive results from pointless treatments… the placebo effect. Fear and uncertainty can worsen symptoms, and we’re wired to respond very well to anyone who confidently and calmly says, “Here’s the problem. I know a way to help it. I’ve done this lots of times.” Putting our trust in such people works against the fear and confusion, and can relieve symptoms, even when the proposed solution is useless or dangerous. That’s why anecdotes and stories of some random poster’s personal experience are so powerful, because they are based on social mechanisms of trust. And those mechanisms can be abused.

    We need real, science-based, double-blind studies to ensure that *any* person who claims that trust – degreed, experienced, traditional or not – is not accidentally or purposely ripping off, damaging or even killing the patients who trust them.

  52. #52 MI Dawn
    April 11, 2010

    @Pen: As I’m sure the anatomy prof taught, while there is a degree of flexibility to the female human pelvis thanks to pregnancy hormones, it is really very minimal (unless you get total separation of the symphasis pubis…very painful) and/or a fracture of the coccyx. And fetal skulls can only overlap so much. If the fetal skull and maternal pelvis don’t match, the baby just won’t come out, and, in the pre-csection days, the mother died, or the baby died, or both.

    @MereMortal: doulas are great for the women who want and need that kind of support. When I was a working midwife, I knew and worked with some wonderful ones. (I also knew some horrible ones, but since, after the first time, I refused to work with them, I rarely saw them.)

    As a doula, I’m sure you were trained to give the mom support. A positive attitude helps everyone in labor. But admit one fact: birth is not perfect. Even in the best world, either women die (if csections are not done) or they have an “imperfect” birth (if interventions are needed and done).

    Even Ina May Gaskin admitted the need for intervention and csections. Perhaps far less than is used in our medicalized society, but she did not, at the lectures of hers I attended, say they were never needed.

    I hope we all agree that the outcome we are looking for is a healthy mother who has a healthy baby (or babies) in her arms. Good luck with your own birth.

  53. #53 Rincewind'smuse
    April 11, 2010

    However, something very critical to note, is that I witness women in spontaneous labor from very early on all the way through postpartum. Meaning, I see the whole spectrum, witness the entire natural process of labor. I don’t show up when she’s pushing or just to catch or to perform a section. Tell me how many OB’s get that experience (and no, inductions do no count)? Not many. And I know that from having personal relationships with OB’s too. So, I do see that as having very valid experience and knowledge with women.

    I don’t know what you think you’ve learned from your personal relationships with OB’s but you’re wrong about this; There are many sleepless OB residents who would take exception to the idea that they don’t see the entire process, and I know because I got to know them well as a sleepless pediatric resident.We both watched the whole process together in the hospital, and no, not just the delivery.

    It’s the women in the hospitals who I think need all the luck in the world!

    Maternal intrapartum and postpartum mortality have decreased markedly in the last hundred years for a reason(no, handwashing is not the whole picture):that you consider it to be a matter of luck speaks volumes.

  54. #54 Calli Arcale
    April 11, 2010

    Jason Brown:

    Lots of Chiropractor bashing going on here. Chiropractic works excellent for musculoskeletal injuries. As far as the other diseases…there is no research to prove or disprove. I think the scientific community needs to accept that not everything can be explained. Strange stuff happens with chiropractic care…but strange things also happen in medicine…just accept it.

    I can certainly accept that not everything can be explained. But before I expect a chiropractic adjustment to cause my baby to turn, I expect some evidence that it even *happens*. And I don’t mean a testimonial. There are people on this planet, right now, who are convinced that killing their next door neighbor cured their ailments. Seriously. Do I need to just “accept” that strange things happen, just because I don’t know how their next door neighbor could have been making them ill? Of course not. Chiropractic is far less sinister, but no more deserving of a free pass.

  55. #55 Grant
    April 12, 2010

    After a bit of digging, this research conference programme (PDF file) throws a little light on Dr. Kruger’s position when taken in conjunction with my previous link (see comment 28):

    http://www.chiropractic.ac.nz/dms/images/custom_content/NZCC_Annual_Research_Conference_2009.pdf

    It seems she holds two positions, one with the university (their research description makes no mention of testing chiropractic treatments [I'm not saying they're avoiding anything, just that there is no mention of chiropractic]) and another with the New Zealand College of Chiropractic.

  56. #56 Poogles
    April 13, 2010

    “It’s the women in the hospitals who I think need all the luck in the world!”

    While all laboring women are partially relying on luck, it is by far the HB group who is relying on it more (at least as far as HB exists in the US at this point in time).

    As someone who once decided that my children would be born by HB (and then, decided it would be a UC!) and then found the scientific support was sorely lacking and the risks were just too high (causing me to change my mind), I will join others here in wishing you and your child a safe homebirth.

  57. #57 Avery Jenkins
    April 21, 2010

    Ho hum. The usual “it can’t be *real* research if *we* didn’t do it argument.

    The fact of the matter is, the most comprehensive research to date (R Sarnat and J Winterstein, Clinical and cost outcomes of an integrative medical IPA, J Manipulative Physiol Ther 27 (2004), pp. 336–347) did show a reduction in obstetric complications with chiropractic care.

    But since that deviates from your religious dogma, I imagine such research will be given short shrift here.

    Dr. Avery Jenkins
    http://www.averyjenkins.com
    http://www.docaltmed.com

  58. #58 Orac
    April 21, 2010

    Why thank you, Avery. Your website provides a target-rich environment, should I ever lack for blogging material. I do appreciate it. :-)

  59. #59 Andrew Gilbey
    April 26, 2010

    Excellent post, thanks, Orac. I read this press release and was, to say the least, a bit suprised. Unfortunatly I didn’t have time to look into it further.

    Couldn’t help but have a laugh at the irony of ‘chiropractor bashing’. Isn’t this what they normally do to the spines of people with, err, subluxations? Albeint under the guise of manipulation.

    Quite how these chiropractors have got to become so powerful is beyond me. There is no alternative medicine. There is just an alternative to medicine. MAybe if proper doctors were just a little bit nicer to their patients, people would just use proper medince!

  60. #60 andrew gilbey
    April 26, 2010

    Dr. Avery Jenkins? I assume that’s Doctor of Chiropractic, Avery Jenkins, rather then Dr Avery Jenkins. Nuff said.

  61. #61 dizi izle
    October 4, 2010

    In my last pregnancy, I was skeptical of Chiro care. I told the Chiro, “This is probably silly, but I have hemmorhoids so I don’t know if you can help that”. She said “Of course I can”.

  62. #62 cialis
    October 22, 2010

    Fun… the immigration thing took SOO long when I went there last year. Do me a favor–turn off the computer, step away, and go outside into that mild UK fall weather. http://www.cialishap.com

  63. #63 muhteşem yüzyıl izle
    January 26, 2011

    ots of Chiropractor bashing going on here. Chiropractic works excellent for musculoskeletal injuries. As far as the other diseases…there is no research to prove or disprove. I think the scientific community needs to accept that not everything can be explained. Strange stuff happens with chiropractic care…but strange things also happen in medicine…just accept it.

  64. #64 Calli Arcale
    January 26, 2011

    Strange stuff happens with chiropractic care…but strange things also happen in medicine…just accept it.

    Even when people die?

    And I’m sorry, but I’m not satisfied with “I don’t know”. Just because don’t know something today doesn’t mean we won’t know tomorrow, and is no excuse whatsoever for never trying to find out.

  65. #65 Matt
    May 15, 2011

    Its sad to see so much hate.

  66. #66 Cappa
    January 11, 2012

    When it comes to pregnancy, I found the absolute most helpful thing is a doula. That mental love and support really beat out everything else I’ve tried, INCLUDING a chiro. It’s really just not necessary in my opinion. And I agree Matt. It is sad.

  67. #67 Mephistopheles O'Brien
    January 11, 2012

    Cappa – just to be clear, you agree with Orac that Chiropractic care is not proven to be useful for either pregnant women nor newborns? That having someone help out is more useful?
    And it’s been a year so I may have forgotten – but I’m not seeing the hate.

  68. #68 JB
    May 16, 2012

    So, let me get this straight… You quack hunters are tearing into a study… that hasn’t even been done yet!!! You claim to be people of science, but can’t even draw the conclusion that spinal nerve roots innervate pelvic floor musculature which could be compromised with postural/structural mal-positioning?!? Please… this is the worst rubbish I have ever heard from skeptics going on about the “quackery of Chiropractic”. If you want more studies to rip into, how about donating some money, because researching DCs sure aren’t getting any large research funding grants from any typical (Drug company) “western” medical duchebags.

  69. #69 Agashem
    May 16, 2012

    Nice re-opening of a thread, but I don’t know what a “duchebag” is so you will have to clarify. Let me ask you, JB, do you have to eat an entire cake to find out it was made with salt rather than sugar? No? This is the same sort of thing, you don’t have to see the final product to know it started out wrong.

  70. #70 Antaeus Feldspar
    May 16, 2012

    So, let me get this straight… You quack hunters are tearing into a study… that hasn’t even been done yet!!!

    Yup. Are you staking yourself to the claim “No matter what flaws may be glaringly obvious in the design and conception of a study, no one can offer any criticism until after the study has been done”? If we announced that we were going to test the hypothesis that giving chiropractors constant electric shocks made them less likely to propose silly studies, would you patiently wait until after the study had been performed to voice your outrage?

    You claim to be people of science, but can’t even draw the conclusion that spinal nerve roots innervate pelvic floor musculature which could be compromised with postural/structural mal-positioning?!? Please… this is the worst rubbish I have ever heard from skeptics going on about the “quackery of Chiropractic”.

    Your terminology is a little sloppy. You use the phrase “draw the conclusion” where there is no body of data to draw the conclusion from, so I think you meant “comprehend the hypothesis” in that sentence. And the answer is, yes, we can understand the hypothesis. Just as we understand the hypotheses that pelvic floor muculature can be compromised by an imbalance of the four humors, by negative engrams the mother heard during the act of her own conception, by a failure to maintain healthy orgone levels, or any of twenty dozen other ideas. What we don’t do is mistakenly think that just because someone has elaborated a hypothesis, that it corresponds to reality. Show us the data which indicates that “spinal nerve roots innervate pelvic floor musculature”. If you cannot, you are validating Orac’s criticism of the study, which is that there is insufficient prior plausibility to the idea.