Panicking chiropractors order slash-and-burn of their own websites

Is that hot enough for you ?

Beautiful!!

"Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else."

Oops!

I created a website for a chiropractor about ten years ago. Having agreed to do it, I became increasingly uncomfortable as the claims racked up - he could prevent and treat anything from earaches to heart disease. I finished the site and turned it over to him, and bowed out. Been trying to make amends ever since.

His website is still up there, considerably modernized. He can afford the really fancy web geeks, along with his Jaguar and his airplane.

Ah, the Streisand Effect goes into overdrive.

It looks like the chiropractors are taking it seriously -- more and more of the archive.org pages are disappearing as well as the Google archives, as they request those files be purged. I hope Yaxu has screenshots as well.

Luna -
Under US law, if someone has done a sudden slash and burn on their backups and shredded the records, the opposition in a lawsuit has a much easier time of it. It is assumed that they were trying to conceal evidence of wrongdoing.

Also, neither Google nor archive.org actually delete the files, they just make them unfindable. Subpoenas usually work.

@7: the US law doesn't matter. This is a British case.

Anyway, taking down a site doesn't automatically delete all backup copies. The site is probably hosted at server hotel that keeps its own backups for its own business continuity reasons. IIRC, the UK law requires that the backups are kept for two years, in case the police developes an interest in them.

@Tsu Do Nimh -- thank you, that is encouraging; but since this is under UK law, rather than US law, I'm not sure how the courts are likely to take it here. Hopefully they would also take the sensible attitude that it is being done to conceal wrongdoing, but it's hard to know how some judges jump. Some of the judges here seem quite divorced from reality.

Thinking about it, though, wouldn't this email about "take it off your sites! Take your sites down!" be evidence that the claims are indeed "bogus", as in "known to be false or misleading"? ...How could it not be?

...On a side note, I have an unrelated question for you about checking things in VAERS. Do you have a disposable email address which I could use to pick your brain, and are you willing to allow me to very briefly and politely pick your brain? (I'm at luna_northcat "at" yahoo.co.uk, for what it's worth.)

Is it just me, or does this letter sound like a hoax?

Seriously, how ignorant would they have to be to think that this emails would stay secret? Then there's the bit about the phones being too busy, so send more emails. Almost as if someone wants to create more discoverable electronic records, no?

@qetzal, I would have agreed with you, except for the fact that the McTimoney site has also been stripped.

Lassi Hippeläinen: "the US law doesn't matter. This is a British case."

While US law does not apply directly, there are several UK statutes that can be applied with regard to the cases that have close US equivalents, and the intent to conceal evidence most certainly is one.

Of course, the real point is that Archive.org and Google are US-based, which means they don't have to do a damn thing based on a UK company's (or court's) request. That, and it is correct that they don't delete so much as make it "unfindable."

Thinking about it, though, wouldn't this email about "take it off your sites! Take your sites down!" be evidence that the claims are indeed "bogus", as in "known to be false or misleading"? ...How could it not be?

Never interrupt your enemy when he's busy cutting his own throat.

Simon Singh was facing a near-impossible legal task of proving that the backcrackers knew that their claims were bogus, but it does seem that they have taken pains to make that task easier.

Absolutely great... The internet never forgets! Is there anyway that the UK assn could be brought to US courts... sorta like the libel venue shopping that takes so much of that to the UK? Good to see the original legal action causing a sh*tstorm right back where it started.

Wow...that's amazing. It's great to see these claims (and as I am an english citizen i will not call them bogus) taken down. At least this whole mess had some positive result, although I suspect it's only a matter of time before they find some other legal loophole to allow them to post at least some webpage claims back up.

Hey, everyone, please note that this is the McTimmoney Association, not other chiropractors. Ask around, and you will find out that the McTimmoneys are allowed to use the title "doctor of chiropractic" or "chiropractor" on a technicality, but that the McTimmoney College is not accredited by any academic authority, and the graduates cannot be licensed to legally practice in any country other than the UK. Sure, there are places like China and Germany where there is no license required to practice chiropractic yet, but there is no country in the world (other than the UK) that will allow McTimmoney graduates to get licensed.

Even the other chiropractors in the UK are trying to get them out. The British Chiropractic Association will not allow McTimmoney graduates to join, which is why they had to form the MCA. The GCC actually denied them the right to use the term "chiropractor", but they sued and the GCC gave them a probationary period to get up to scratch rather than pay for an expensive and drawn out lawsuit.

Say what you will, but do not confuse the McTimmoney Chiropractic Association or McTimmoney practitioners with other UK Doctors of Chiropractic who actually had to go to a real school and who took real classes to get their degrees.

U science nerds seem to think you are above the law.u are not and will all burn in hell. the god u fight and dont believe in lives and will punish you for not believeing

Guys, that's not a reliable method of preserving the evidence--Google's cache isn't designed as an archiving tool, and you can get your material removed from archive.org (assuming you know it's in there in the first place). I think we need a community effort to store local copies of some of the pages from archive.org, before they wise up and take them down.

So, if you've got a moment to spare, browse through the list at: http://yaxu.org/tmp/chiros.html
Look particularly for:
-Sites claiming to treat conditions like colic, where the debate is focussed (or at least, which are most likely to be wrong).
-Sites which have already been taken down, but are still in archive.org (to show that they're taking them down now).
-Sites about clinics in the UK (since that's where the lawsuit is!)

There's no completely foolproof way to prove that the copy we collect is unaltered, but the I think the best bet is:
-Take a screenshot, being sure to include the address bar to be clear where the site is.
-Print the webpage as a PDF--this should have the address stamped at the top, and is hard (though not impossible) to modify. If it's a flash (swf) based website, though, this won't work, but if possible, please save the swf file--these can't easily be modified either.

I've already done a few, but independent duplication should help to show that we're not faking screenshots. Step up, netizens, and hoard evidence.

science nerds rule!

god drools!

Don't worry, I've got a copy of every site in question in a database. It's not going anywhere fast.

The GCC have got a copy of the ones relevant to the 55 complaints I made this week.

" Doctors of Chiropractic who actually had to go to a real school and who took real classes to get their degrees."

*twitch*

To #16 "God". The god of spelling and punctuation will have your nads for earmuffs for your crimes against language. All you have done is prove the inverse intelligence/education to religious ratio.

Does it make you feel all warm and fuzzy to make believe that your god will toast non-believers for eternity? Says a damn sight more about you than it does about non-believers.

Have chiros heard of Teleport Pro? I have. Bingo!

qetzal
... Seriously, how ignorant would they have to be to think that this emails would stay secret?...

These folk are bumbling cretins, with zero concept of reality.
They believe that magic-mumbo-jumbo will cure infant asthma, some even say that back-cracks can cure cancer!
(Unless they mean that killing your patient provides a cure for all known illnesses.)

"Ignorant" is too kind a word for their willfully delusional meglomaniacal mindset.

Critical Reading,

I'm pretty sure you'll see BCA logos on some of the affected sites. Perhaps this is because they employ different chiros who are members of different associations but to outsiders, it still looks like the practise is a BCA member.

As I see it (I'm not a lawyer), this event has little bearing on the Singh case. Simon has argued that he does not believe the BCA were knowingly fraudulent. Even if there was evidence to the contrary (ie: that they were), it wouldn't help his current appeal since that's the very claim he's opposing.

If he's forced to go to trial and defend the current ruling, it might provide some comfort but given that it isn't the BCA issuing this warning, it's difficult to see why a court would pay the least bit of attention to it.

Andy D,

I agree. This sitation has nothing to do with the Singh case. . . which is why I didn't mention the Singh case at all. This blog is about the stuff the McTimmoney Chiropractic Association sent out. The only reason I mentioned the BCA is because they are the largest association of chiropractors in the UK, and they do not accept that the McTimmoneys are adequately trained.

My point was that this insane e-mail was sent out by a tiny subsection of the population, and is not representative of chiropractors as a whole.

Thanks for pointing this out.

Realizing that I may be condescending to those of you with a more scientific background, I think it can be helpful to clarify something for the laypeople in this thread. . .

Lack of evidence about a treatment does not mean that it is a "bogus" treatment. In order to call something "bogus", you actually do need evidence, evidence that says it doesn't work. Lack of evidence means that their is neither evidence saying it works nor evidence saying that it doesn't work.

For example, there is a lack of evidence verifying the effectiveness of the vaccine Gardasil to prevent HPV infection when provided to girls under the age of 18. This is because the clinical trials were done on women age 18-24, and 24-35. This doesn't mean that giving Gardasil to 12 year old girls is "bogus", even though there is no evidence that it works in this age group. What it does mean is that it is unethical to experiment on children who are not able to give consent to the researchers providing the "experiment" intervention.

This could also explain why there are not clinical trials about chiropractic treatment for children. (i.e. there is a lack of evidence)

I am neither for nor against chiropractic treatment. I know a few chiropractors, most smart guys and one who is a little wacky, but it is not something I have ever been interested in trying for myself.

I am also, however, not impressed by the witch hunt.

Those who work in the scientific literature circles can verify that in order to have research on something, you need to have significant funding to do the studies. There is not much research on chiropractics, but there is almost no funding available to perform this research, as opposed to the literally billions spent on pharmaceutical research each year. Taking this into account, the strongest information out there in support of chiropractics is for back pain and neck pain. Hopefully we will have additional quality research on chiropractics in the near future, and then we can actually know which claims are supported and which are "bogus" and should be cut.

This is just awesome. Strong work from everyone involved.

I don't really buy what "Cochrane Reviewer" says about there not being funding to do Chiropractic research. Chiropractic is clearly a large and profitable business, both in the UK and (especially) the US. It would be perfectly feasible for serious trials to be funded. NCCAM in the US alone has spent US $2.5 Bn on CAM research, sadly mostly wasted. And the chiropractic schools and Universities are at great pains to tell us their staff do research. However, poor quality research predominates, published predominantly in chiropractic house journals where all the reviewers are probably others of the faith.

There is also the problem that a strict focus on trials does not give any weight to underlying biological rationale and inherent plausibility (or lack of) - what one might call the "prior probability" argument. One can generate systematic reviews of poor-quality evidence, and come up with a verdict of "well, who knows, more research is needed". But should that then be used to say "carry on, it's fine, and you can't say it's crap" when the therapy has zero theory of causation that anyone would buy and is inherently utterly implausible?

The obvious example of this is homeopathy, but one can certainly apply the same argument to using chiropractic to treat things that are unrelated to the spine, or to musculoskeletal problems.

Incidentally, whenever I see someone refer to

"the literally billions spent on pharmaceutical research"

- in this kind of way, my bias filters begin to twitch. The statement may be true, but used in the manner above it smacks of someone with an agenda. Plenty of medical, and certainly basic biomedical, research is NOT funded by the pharmaceutical industry.

I'm afraid Cochrane Reviewer is also incorrect about whether or not there is actual evidence for efficacy of the HPV vaccine in 12-year-olds. There are at least three (I'm not sure about several more, but I *know* there are three^) studies which included cohorts of 9-12 year olds (n>2,000 overall) -- and while these were not tracked over the next two years to see how many of them acquired HPV infections (given that the hope was that they were not sexually active), their immune response WAS tracked, and the immune response either matched or exceeded that of the older cohorts. Therefore, unless you have a good reason to think that susceptibility to infection operates independently of immunogenicity, there is evidence.

Given that these are all high-quality blinded trials, with consent both from the children and the children's parents, and which have been passed by all the relevant ethics review boards, this bespeaks a little bit of ignorance of the field. ...And comparing this to chiropractic practices which have either never been through high-quality trials or which have failed to demonstrate efficacy...that is also incorrect.
----
^ 1.) Pederson et al. "Immunization of early adolescent females with human papillomavirus type 16 and 18 L1 virus-like particle vaccine containing AS04 adjuvant." J Adolesc Health. 2007 Jun;40(6):564-71.
2.) Reisinger et al. "Safety and persistent immunogenicity of a quadrivalent human papillomavirus types 6, 11, 16, 18 L1 virus-like particle vaccine in preadolescents and adolescents: a randomized controlled trial." Pediatr Infect Dis J. 2007 Mar;26(3):201-9.
3.) Block et al. "Comparison of the immunogenicity and reactogenicity of a prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in male and female adolescents and young adult women." Pediatrics. 2006 Nov;118(5):2135-45.

I have yet to be aware of any major sources of public funding for chiropractic research. The $2.5 billion spent on CAM research over the last 10 years includes hundreds of different therapies, of which Chiropractic Manipulative Treatment is only one. Also, the majority of research being done at the Universities is actually funded out of that same $250 million a year ($2.5 billion over 10 years) allocated to CAM research. (See the credits of the publications from institutes at Southern California University of Health Sciences, Pallmer College of Chiropractic, and Northwestern Health Sciences University, among others.)

This being said, $250 million a year may sound like a lot of money to any one of us, but then we remember that it costs an average of $250-$500 million to develop just one pharmaceutical medication from discovery to finished product (Shuster, B. JACM 2001). When we realize that the annual sum total of all governmental funding for all CAM interventions (of which chiropractic is only a small part) is equivalent to what it costs to develop just one drug, or maybe even only half of one drug, we see how they really compare.

Furthermore, NCCAM, in the US, is currently funding just 3 studies on chiropractic interventions. ClinicalTrials dot gov (a registry of all publically funded trials in progress in the US) lists 74,322 clinical trials currently ongoing in 167 countries. I don't think that 3 out of 74,322 can really be considered adequate governmental funding of research on chiropractics. This, of course, is only public funding. I had not mentioned the funding done by the pharmaceutical industry, itself, I was just speaking about research on pharmaceutical interventions in general, without any reference to where that funding might be coming from. So take that 74K and tack on a bunch of industry funded studies, too. That just makes the numbers even more lopsided.

It was suggested that, since chiropractics is a large and profitable industry, they should be able to fund their own studies. We all know that this was a ridiculous statement. When was the last time we heard of a bunch of doctors getting together and privately funding research on hip replacement, or the latest statin?

Plus, there are fewer chiropractors and they don't make as much as regular doctors. The average salary for a chiropractor in practice for 5-9 years in the US is about $60,500 a year. The equivalent average salary of someone with an MD degree who has been in practice for 5-9 years is $152,000. (This data from payscale dot com). Given that there are about 60,000 chiropractors working in the United States, that comes to a approximated grand total of $3.63 billion. Out of this, on top of privately funding major research, they do all still have to pay rent, eat, put their kids through college, etc., of course.

Comparatively, the company Merck made $4.5 billion on sales of Vytorin, alone, in 2007 (merck Website and summary release by Sophia Pearson.) Vytorin is only one of the approximately 100 drugs on the Merck list of products. This is great for them, and shows that they are making quality products. However, it is pretty clear to see why one industry can afford to privately fund self-validating research while another cannot.

Naturally, however, even when all of the chiropractors donate 30-50% of their annual incomes so that research can be done, it will still be accused of being biased or of low quality. After all, it would be chiropractors paying to research themselves. . . of course it will be a biased outcome, right?!?

Dr Aust, you have accused me of making true statements, but which "smack of someone with an agenda." I take a very personal interest in accusations of bias, but generally an academic interest, if even, in chiropractics. You, however, have major anti-chiropractic statements on your personal blog, including the posting (on May 26, 2009) of "Back crack quack attack â the song" together with the statement;

"Not got round to doing any extended chiropractic debunking as yet, though I am enjoying tremendously seeing what the rest of the posse have been up to. Anyway, as a small contribution, I thought that perhaps the counter-Chiropractic unreality movement needed a theme song. So here is my attempt."

I suggest, sir, that you save your half-truths and out-of-context statistics for the generally uniformed public. They don't fly here.

For Luna,
Observational studies of immune response in children between the ages of 9-12 would not be considered sufficient to extrapolate the specific response to HPV exposure that wouldn't take place for (at least) 10 years. Unless you have a study in which the children are either sexually active, or you review them 10 years later when they would become sexually active and therefore potentially exposed, then no, you don't have evidence of the response to HPV when children are inoculated with Gardasil.

I would furthermore suggest that 2 years would not be a sufficient period to track these children to see if they develop HPV infections. . . unless you are suggesting that a statistically significant proportion of this population of children is going to go out and start getting themselves exposed.

Short term increased immune activity simply means that the children are having an immune response to the antigens in the immunization. . . which is what they are supposed to do. Any immunologist, however, will tell you that children have a greater immune response to an antigen than the average adult because they have been exposed to fewer things in their short lives and, consequently, have to build every new response "from scratch". Since there are about 130 identified strains of HPV, most adults will have come into contact with one or more of this family of viruses, and will therefore not respond as strongly as would a child. Of course, Gardasil does not protect against all 130 strains of HPV, but flu vaccines work because there will be an overlap in antigenicity, and the principle applies here.

The reason the study in the older individuals can be significant is because, presumably, they were actually exposed to the virus in question. Without a population that is exposed, blinding the study actually doesn't mean anything. If you can pull a study in which a population of sexually active children were inoculated, I would love to see it. Otherwise, I would suggest that it is pretty tough to do a legitimate test for an STD on a bunch of virgins.

This being said, I will admit that Gardasil is not a specific area of interest to me. I am familiar with the more widely available, quality research, but since my job is to read this stuff all day, I don't really go looking for it in my free time.

"Cochrane Reviewer"

I am happy to identify myself as part of what George Lewith calls "the Anti-CAM-brigade", although personally I prefer the term "pro-Reality". I used not to be anti-CAM - honestly - but three years of dealing with the obfuscations, bluster and special pleading of CAM folk and their apologists has hardened my attitudes.

"...it costs an average of $250-$500 million to develop just one pharmaceutical medication".

...Which is totally irrelevant to a discussion of CAM, as you surely know, as such a figure tells us NOTHING whatsoever about the cost of doing CAM research.

1. Part of the kind of figure you quote is lots and lots of "basic research" to identify drug targets and potential drug structures, and test them in model systems and animals. This has no parallel in testing CAM interventions, since with something like chiropractic we know what the intervention is already.

2. Another cost element with pharmaceutical development is the "lost" cost of drugs and strategies that did not make it to market because they failed in the development process. Again, zero comparison in CAM - NO CAM intervention has ever yet been abandoned because it was shown to be ineffective. Not even the ones that have been clearly shown to be ineffective.

3. A major part of the cost figure for a pharmaceutical remedy reflects how many regulatory stages there are in licencing a drug. Much of the cost of pharmaceutical medicine development results from the need to make sure any new drug is tested for efficacy, and especially for safety. These are tests that are REQUIRED before the medicine can be sold.

They are also tests that CAM therapies, with minimal exceptions, never have to undergo. In the UK the most stringent requirement is for herbal medicines, which when marketed (as they invariably are) as "food supplements" merely have to demonstrate that a review of the available literature reports no evidence of harm.

With pharmaceuticals, the trials required for things like safety approval are enormous in scale. In CAM, we typically don't even have reliable small trials for efficacy. In the case of something like chiropractic for colic, one of the subjects of the BCA vs. Singh libel case, there are NO blinded trials with more than 100 participants - I count one trial with 50, and another with 100. The cost of such a trial, I would contend, would not be prohibitive. A trained observer for a year, maybe? I assume the chiropractors would be happy to sign up, indeed would want to participate - at least, assuming they are actually interested in substantiating their practices with reliable evidence. And given the ever-increasing number of CAM-interested academics in mainstream Universities, let alone the CAM schools, I am sure one or more such could be found to spend the time to carry out such a study.

As to (I paraphrase) "they can't do it because there are no industrial conglomerates to fund it":

Ho hum. Are you really telling me that you think Chiropractic Associations which promote such treatments, and practitioners who dish them out, and Universities which teach them to their students, have NO responsibility for asking whether there is any evidence they work? Or for trying to test them if they are insufficiently tested? Frankly, that strikes me as the contemporary equivalent of Pontius Pilate washing his hands.

Now, since you have drawn attention to my "potential conflicts of interest" - namely being a conventional biomedical scientist who holds the opinion that CAM advocates routinely get away with a ton of "elisions" and special pleadings that would be instantly red-flagged in conventional science-based medicine - can we please know what yours are?

Cochrane Reviewer's original paragraph:

For example, there is a lack of evidence verifying the effectiveness of the vaccine Gardasil to prevent HPV infection when provided to girls under the age of 18. This is because the clinical trials were done on women age 18-24, and 24-35. This doesn't mean that giving Gardasil to 12 year old girls is "bogus", even though there is no evidence that it works in this age group. What it does mean is that it is unethical to experiment on children who are not able to give consent to the researchers providing the "experiment" intervention.

First: I think I was incomplete in my response to this. After all, you are claiming that efficacy has never been tested in under-18s. This is flatly false, as not only the three studies I cited, but also a number more specifically reviewed not only immunogenicity but also efficacy against infection in the 15-18 age range.

Second: You are specifically stating here that "clinical trials were [only] done on women age 18-24, and 24-35." False, as above.

Third: You state that "it is unethical to experiment on children who are not able to give consent to the researchers providing the 'experiment' intervention." How, then, do you explain the fact that there have patently been IRB-reviewed, gold-standard studies of this involving children? Again, false.

Further Cochrane Reviewer:

Unless you have a study in which the children are either sexually active, or you review them 10 years later when they would become sexually active and therefore potentially exposed, then no, you don't have evidence of the response to HPV when children are inoculated with Gardasil.

Fourth: I pulled the 2-year follow statement from the fact that some of the studies have only had that time window in which to publish immunogenicity reviews, and if you had read what I said, I (and the research!) specifically state that sexual activity is not expected in that age range, for dog's sake. There HAVE been 18-month follows, which confirmed continuing immunogenicity. Immunogenicity has been confirmed at 5 years with the older cohorts in other studies. However: YES, there are going to be 5-year and 10-year follow-ups with the clinical subjects, according to some of the research.

Finally: Not only are you throwing out a bunch of completely irrelevant stuff about the number of HPV strains, given that only a handful are strongly associated with cancers or warts (and ignoring - unaware of? - the research which indicated overlapping immunity against different HPV strains), you are indeed arguing that immunogenicity to specific pathogens and susceptibility to infection by those pathogens are independent. Holy crap. No, seriously. What?

CR also said:
"Any immunologist, however, will tell you that children have a greater immune response to an antigen than the average adult because they have been exposed to fewer things in their short lives and, consequently, have to build every new response "from scratch"."
--To which I can only say, really? That's funny, because I've spoken to a number of immunologists over the years, and I don't recall any of them saying something like that. Young children do have a higher number of naive T-cells and probably a greater plasticity of immune response...but "greater immune response"? I would like to see legitimate citations supporting use of that phrase.

All of which, while interesting in itself, is also secondary to the main point -- which is, you are claiming that the extensive research done on the usefulness of the HPV vaccine in youngsters is pointless and proves nothing, apparently in order to hold the situation up as analogous to the complete lack of research supporting the efficacy of chiropractic interventions on unlikely things like colic or asthma (the ability of chiropractic intervention to help some forms of musculoskeletal pain and tension headaches actually has some clinical support). In order to cliam chiropracty has an equal value to accepted treatments, rather than provide a decent standard of trials and clinical evidence, you are falling back on the hoary alt-med tactic of claiming that evidence-based medicine is no better.

That honestly doesn't wash, I'm afraid. And so far, you are not demonstrating a good understanding of trials, either. I appreciate that HPV may not be your main focus -- but if you're going to try using it as an example, frankly, you ought to at least make sure you have your facts straight. And you don't, which does not impress.

Dr Aust,

I am not sure why you want to take a conversational thread about an ongoing legal situation in the UK and turn it into your own personal soapbox, but clearly it is something you are passionate about.

I am not sure what point you were making by explaining the process of pharmaceutical development. Yes, I simplified by saying the cost was from discovery to finished product, but you aren't telling us anything we don't already know. To clarify further, that number ($250-$500 million) is the cost for a project which takes an average of 12 years.

Essentially, who cares. My point was that research, all research, is expensive.

I did not have any particular data on what it costs to run chiropractic research, but a quick search of the net popped up the recent grant from NCCAM to the Consortia Center for Chiropractic Research, which is the facility located at the school in Iowa. They were awarded $2.7 million for the next 5 years:

- To establish a bibliographic resource on chiropractic topics;
- To develop and implement research workshops, seminars, and educational materials;
- To establish a network of chiropractic clinicians and investigators in specific topical areas;
- To link investigators with the technical expertise necessary to pursue research goals; and
- To establish prioritized research topics and implement research.

All of this is preliminary work, none of that is actually going to any research!!!

The chiropractic university in Minnesota does appear to have received either $1.5 or $3.4 million for a three year study on acute neck pain in 2001 (conflicting data. . . larger number appears to be a total for 3 studies). From the paper published by them, it appears as though this study included 28 patients.

I also found that the total NIH budget for research is about $20 billion, of which $10 million is spent on chiropractic.

Sure, when you compare this cost to what it takes to develop a pharmaceutical from discovery to finished product (yadda yadda yadda. . . including all of the stuff that you said) the chiropractic research is less expensive. It is still, however, far beyond the scope of a few private practitioners.

I do not know enough chiropractors to make a statement here, but to put things in perspective, when was the last time that you gave between 10 and 50% of your annual income to support research validating what you do? You say this cost should not be prohibitive, but I must ask, what would seem prohibitive to you?

You say that the universities should foot the bill, but as we are well aware, the chiropractic universities get no public funding and are entirely tuition dependent. Are you suggesting they should double the tuition for all students (when they already come out of school 150K in debt) to pay for this research? Doctoral students don't have to pay double tuition in order to support their research. The funding for research done at Johns Hopkins, and the University of Maryland, and all of the other Universities that do research, is not actually paid for by the university. There is always outside funding.

Okay, well why not the professional associations? That is ridiculous. None of the health care professional associations do research. They can't afford to. Even the American Medical Association, which is many times the size and has several hundred times the budget, doesn't do research. They have a "seed research grant program" which awards a few $2500 grants (yep, that's twenty-five hundred, not million or billion) to young docs interested in small studies, but that's it. The things eligible for the AMA Foundation include:
1. Tuition assistance scholarships to medical students
2. Public health mini-grants
3. Free clinic programs
4. Medical Student, Physician Resident and Physician Fellow research projects (Seed Grant Research Program; National and Regional Student Research Forums)

Why would you ever think that a private university or a professional association should fund this research? That is not the standard for any other branch of health care, and it should not be the standard here. Making statements such as those shows only your bias or your ignorance; I'll let you decide which it is.

There are a lot of conventional biomedical scientists who are open minded and without bias towards CAM therapies, myself included. Your bias is personal, and you blame it on anything else.

I have no relevant conflicts of interest. I am a systematic reviewer / analyst and I teach professional ethics. Sorry, I don't have my own website or blog.

Nice to see at least some degree of rational thinking returning to the chiropractic debate instead of all chiropractors bad...Mr Singh(non clinical private citizen) good.
Ho hum....takes all sorts..I suppose.

Luna,
I honestly cannot tell whether you are just misunderstanding me / misinformed, or actually doing this on purpose.
I am not sure if you understand what immunogenicity is, but it relates to the general capability of an individual to produce an immune response and, by association, the cause of that response. In order to test efficacy against infection with HPV, you would have to have a population that was specifically exposed to HPV. Read your research again. You do not have a study where they immunized 15 year olds and then exposed them to HPV.
Long term efficacy has not been tested in under-18s. The vaccine has not yet been around long enough for long-term studies. This is not an indictment of the immunization, it is a statement of fact. You can't have 30 years of data on something that is 10 years old. Of course sexual activity is not expected in that age group, but demonstrating continuing immunogenicity after 18 months says nothing more than, yes, after 18 months, they are still capable of producing an immune response. I expect that the long-term studies will be positive, in fact, I have little doubt of it. What I am saying is that there is not yet research PROVING that immunizing a 12 year old girl against HPV will decrease her risk of contracting it when she is exposed to it at the age of 34. I am not saying that we WON'T be able to prove it, but I am saying that it has not been proven YET. Are you still with me?
I was talking about the number of strains of HPV to support the statement of overlapping antigenicity. Not sure why you think this is irrelevant, when it is actually the point I was making. . . unless you are suggesting that the entire conversation is irrelevant to the string that we're actually posting on, in which case I would say that you are right. This is a discussion of WHY there is not a lot of evidence on chiropractics, not how the Gardasil vaccine works.

If you would like us to believe that you have spoken to immunologists so extensively and so much over the years that you would have specifically had this conversation, then fine, we will believe you. We will believe both that somehow you know several immunologists (which would be something, as there are not that many of them around) and that you spoke to them specifically about all aspects of the development of immunity. In this case, however, we will have to assume that maybe you have forgotten part of the conversation or maybe didn't understand what was said. It is an accepted fact that the physiological response, including the immune response, is different in a child than in an adult. If children were not different, why would we even be talking about needing to do studies specifically on children at all?
Going on. . . I am not saying anyone is good or bad, or pointing out the weaknesses of one system as an excuse for the weaknesses in another. I drew comparisons between a few specific situations, while also saying that " Hopefully we will have additional quality research on chiropractics in the near future, and then we can actually know which claims are supported and which are "bogus" and should be cut."
I did enjoy your statement, however, given that it is almost identical to comments Dr Aust has posted elsewhere. That, combined with the fact that you post right after him and use similar misrepresentation of facts and twisted statistics, and also that you seem to be tag-teaming a ridiculous argument, looks a little suspicious.
Oh well, it doesn't really matter, does it? The beauty of online anonymity is that you can post whatever you like under whatever name you like as many times as you like and it won't make your argument stronger for "either one of" you.

Well, since interest in this blog seems to have died off, and no one but the many personalities of the "Anti-CAM brigade" seem to be interested, I think I'll take a few days off. I am sure I will check back to see if there is anything worthwhile or of interest on the actual topic at hand, but I'm not interested in spending my time defending chiropractic. I am sure there are other people, maybe actual chiropractors, who could do it better than I would. I was, after all, just offering some information from inside the world of research so we could put all this hullabaloo in perspective.

Cochrane Reviewer

Re the diversion on pharmaceutical funding, I note you said in one of your earlier posts that you were speaking slightly to the lay audience. So can you blame me for doing the same? You know all that stuff already. Fine. Not everyone does.

And anyway, most academics like a nice soapbox. I am no exception. I am also an opinionated type, and I have a blog. It occasionally even tries to present things in a humorous way. Now, I can see you don't find it funny, but Que sera sera, as they say.

----------------------------------------------------------

Anyway, let me try and separate facts and opinions, in a "for instance":

Let's take chiropractic for infants with colic - which is, all agree, distressing for parents, but is self-limiting.

There are some older observational and "survey-style" studies, reported in the chiropractic literature, that report favourable outcomes. These presumably have considerable selection, observation, and reporting biases, which I guess you would know more about than me.

Then there is a 50-participant controlled trial with slightly positive outcomes, but less than perfect blinding.

Then there is a 100-patient randomized controlled trial with a blinded observer that reports absolutely no effect.

These studies have been systematically reviewed - notably by a duo consisting of a chiropractic researcher and a paediatrician - and the conclusion was that the best evidence pointed to the view that there was no efficacy of chiropractic for colic.

-----------------------------------------------------------

Now, here comes me offering AN OPINION. This seems to me to conform to an oft-seen pattern with scientifically implausible therapies - especially ones assessed by subjective observation - namely that poorly-controlled experiments show apparent positive effects that progressively disappear in better-controlled trials.

More opinion: do we need more research on chiropractic for colic? I don't think so, personally. To me, we have enough to say it likely has no basis beyond placebo. I would argue that public research funds shouldn't be used to chase validation for something that the evidence strongly suggests is hokum, especially when money is short and there are more pressing things to fund. If a private Foundation wants to fund it (and ones that fund CAM research do exist in many countries), fine. But not on my taxpayer's dime, thanks.

More opinion: given the above, I think is it appalling that something like a third of all UK chiropractors have been claiming on their websites that they can help infants with colic. The chiropractic profession in the UK have been claiming over many years that they are well-regulated and that therefore the public who consult them can be sure they are protected from harm, including from over-blown claims.

...huh?

Further, much of what the "activists" have been highlighting in the complaints against the UK chiropractors are things which are fairly evidently in contravention of the chiropractors' own pubished ethics codes. How does that sit with you as a professional ethics teacher? It is also clear, I would say, that these codes have been fairly slackly enforced by the GCC, the statutory regulatory body for UK chiropractors. Being nice, this is perhaps because they have been unaware of these breaches. (Though it strains my credulity to believe this, given that the chiropractors sitting on the regulatory body are sometimes the very same practitioners making the dubious claims).

To me, the things that the chiropractic bodies in the UK are now doing - telling their members to make sure their websites accord with the law and with their own published ethics codes - are what they should have been doing already.

And let us not forget, the BCA started all this by suing someone who publicy called them on their sillier therapeutic claims. And they kept on suing him even though they were offered a right of reply to put their side of the argument, in the same newspaper where Simon Singh pubished his article.

So is this a witchhunt against chiropractors? Or is it a piece of "citizens' action" designed to hold the chiropractic profession in the UK to account, and make them "walk the walk", as well as talk the talk? I know which I think. But that's just my happily biased opinion.

PS Re your last posted comment, Luna_the_Cat is not me. Or me him/her. I think your biases may be showing.

Hmm. I have posted a response, but it is stuck in the spam filter as it has a couple of links in.

PS For the record, I am not, nor have I ever been, Luna_the_Cat.

~Nor, for the record, am I Dr. Aust. Sorry. (Well, ok, not really.)

But sweet jumping zombie jesus, CR, talk about tying yourself into knots to avoid admitting you're wrong on anything. You know, some of the various studies on the HPV vaccine(s) are available full-text, free; you could could actually read them to see exactly why claims are made about how immunogenicity overlaps with protection against infection (hint: seroconversion & immunogenicity in the older cohort was mapped against 5-year protection against infection, and no, this in no way needs to involve deliberate exposure to HPV), why claims are made about it being useful to immunise younger girls (hint: much previous research has demonstrated that the highest risk period for infection is the first 5 years of sexual activity), why claims of long-term protection are plausible (hint: HPV vaccines have been around longer than you seem to think, and follow-ups of more than 5 years' duration are possible^), and, above all, it might be useful to you to doublecheck what you think of as your understanding of immunology. Speaking just for myself, if you have anything at all to do with research I will happily wager my right arm that it is not within any medical field. And gee, I had no idea immunologists were so rare, given the number of them in the local chapter of the BSI. I make no claim to having spoken to all of them, but I keep tripping over 20 or so who appear to be local to the University of Aberdeen.

On one thing, and one thing only, you are technically correct: no, we have not PROVEN that a vaccination against HPV at age 12 will protect a woman against HPV at age 34. Nevertheless, where you are not correct is that we do have evidence which leads us to believe that this is plausible -- unlike where we stand with many chiropractic interventions -- and we will be able to test this with real-world monitoring over the next couple of decades -- unlike with many chiropractic interventions. But you know what? You were shifting goalposts with this claim, anyway; I was responding to your original post where you made the claim that efficacy had never been tested in under-18s, which is quite simply, quite flatly, wrong. ...Seriously, people would probably respect you more if you were capable of saying something like "ok, I was mistaken about that."

But, having dodged responsibility for your original statements entirely, accusing me of deliberate misunderstanding, attempting to patronise me, and accusing me of being a sock puppet, you are now going to "take a few days off." That's nice; always a good "out" from a conversation where you're getting slammed, I suppose.

Bye-bye.

-----------------
^ For one thing, the FUTURE II Study Group is still involved in the 15-year follow-up, but has shown few signs of waning protection at 5+ years. For interest you might also look at Schiller et al., "An update of prophylactic human papillomavirus L1 virus-like particle vaccine clinical trial results", Vaccine Vol. 26, Supplement 10, 19 August 2008, Pages K53-K61.

Lets get real here...If practices within medicine were placed under REAL scientific scrutiny(and not drug company endorsed pseudoscience)then only some 50% of todays medical procedures/pharmacology would be considered viable the other 50% would be viewed as abject quackery or at best down right dangerous.

Have a nice one

....Aaaand here we have the obligatory fake-dr. "But EBM is just as bad!" troll.

By the way, Dr. Aust: I am a "her". :)

Thank you "her"
I note as always insults are the last refuge for those seeking to avoid reality..........can it be possible that general medicine has a goodly portion of poorly evidenced porridge.......sprinkled with plausible sugar.
Go find yourself a tame MD(an experienced one) and ask that question.......you may be shocked at the answer.
Welcome to the real world "her"

Real Doctor....have a nice one...if you can.

Ho hum. "Dr Mike", are you, or have you ever been, a chiropractor? Or a naturopath?

"..If practices within medicine were placed under REAL scientific scrutiny (and not drug company endorsed pseudoscience) then only some 50% of today's medical procedures/pharmacology would be considered viable... the other 50% would be viewed as abject quackery or at best down right dangerous."

This is an updated variant on a tired old line peddled by Alt.Medicine (and general Alt.Reality) enthusiasts. It has been repeatedly debunked, an example being on neurologist Steve Novella's blog here.

Anyway, the credible modern estimates are that 75-80% of modern medical practice is based on high-quality evidence, while the other 20-25% is based on reasonable evidence. The evidence, and the practices, are under constant re-examination and revision.

In contrast, most of alternative medicine is based on lousy, or no, evidence. And it is often founded in mystical principles handed down by "founders" who were pre-scientific folk of a mystic mindset (e.g. homeopathy) or plain old fashioned hucksters (e.g. chiropractic). In some cases the practitioners spend a large part of their time arguing about who is more true to the "founding principles", and/or who is a heretic for any deviating from them.

Any resemblance of this behaviour to religion is not in the least coincidental (in my opinion, I should stress).

PS Luna, I figured the name probably indicated female... but one doesn't like to assume.

Anyway, the credible modern estimates are that 75-80% of modern medical practice is based on high-quality evidence, while the other 20-25% is based on reasonable evidence. The evidence, and the practices, are under constant re-examination and revision.

Aust Buddy........other 30-40% reasonable evidence, come on buddy.The practice you refer to is anything but reasonable.....it is tradition based....it is done because it is done and at the end of the day it gets the patient out of the surgery.
Eg facet joint injection......does not resolve chronic inflammation...heck this has been known for years but we do it anyway. Joint steroid injections......yet anothewr well known placebo....Failed back surgery,lets not even go there.

Chiropractic has a well old and established research base...Oh don't take my word for it luck up the literature yourself.

Singh made a fool of himself as a layperson commenting on matters he knows nothing about he stirred the anger of a noble very well organised and internatinally established profession...which as a last resort had to give the big mouth a public thrashing....let that be a lesson to others who feel they can publically say what ever they damn well please whether right or wrong.

Have a nice one.

Somebody was asking for viscer-somatic type research.....would that sombody get working on these. Lets forget big mouth Singh
that all knowing layperson who can not be bothered to research the facts ...lets get down and dirty GO.

Sixteen Infants with Acid Reflux or Colic Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation: A Retrospective Analysis of Outcome
J Pediatric, Maternal & Family Health - Chiropractic May 2009: 1â7

Comparison of the Short-term Effects of Chiropractic Spinal Manipulation and Occipito-sacral Decompression in the Treatment of Infant Colic: A Single-blinded, Randomised, Comparison Trial
Clinical Chiropractic 2008 (Sep); 11 (3): 122â129

Chiropractic Management of Infantile Colic Clinical Chiropractic 2004 (Dec); 7 (4): 180â186

Vertebral Subluxation Correlated with Somatic,Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care
Journal of Vertebral Subluxation Research 2004 (Oct 1: 1â23

Differential Compliance Instrument in the Treatment of Infantile Colic: A Report of Two Cases J Manipulative Physiol Ther 2002; 25 (1) Jan: 58â62

Chiropractic Management of an Infant Experiencing Breastfeeding Difficulties and Colic: A Case Study
J Clinical Chiropractic Pediatrics 2000; 4 (1): 245-247

The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer
J Manipulative Physiol Ther 1999; 22 ( Oct: 517â522

Chiropractic Care of Infantile Colic: A Case Study J Clinical Chiropractic Pediatrics 1999; 3 (1): 203-206

Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases J Manipulative Physiol Ther 1989; 12 (4) Aug: 281â288

Oh' please do not reply that the research was fixed....that is the province of medicine in partnership with drug companies

Have another nice one.

Hm, let's see.

"Sixteen Infants with Acid Reflux or Colic Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation" -- not blinded, no controls, tiny sample size, and the "researcher" performing the treatment performs such treatments for a living. Concludes that the treatment helps. Oooo, wotta surprise.

"Comparison of the Short-term Effects of Chiropractic Spinal Manipulation and Occipito-sacral Decompression in the Treatment of Infant Colic: A Single-blinded, Randomised, Comparison Trial" -- No control group, no comparison to standard non-chiro treatment, comparison of two different kinds of chiropractic manipulation, appears to conclude that there is essentially no difference between them.

"Chiropractic Management of Infantile Colic" --TWO whole case studies, only one of which had a standard medical diagnosis to begin with. No control. No blinding. Conclusion that the chiropractic treatment resolved all symptoms over the course of three weeks of treatment. ...I'm sorry, but, how are we supposed to tell any supposed benefit of the chiropractic manipulation from simple coincidence? Is there anything there that I have missed which would indicate "this is definitely the result of chiropractic manipulation, rather than more soothing cuddling + time"?

"Vertebral Subluxation Correlated with Somatic,Visceral and Immune Complaints" -- So, not having access to the full article, what I can tell from the long version of the abstract is that the authors "randomly" chose children who were already attending practices for chiropractic manipulation, described what they consider to be a "new" form of pelvic dysplasia, and theoretically linked multiple health syndromes to this dysplasia. Did I miss anything? Like, how did they prove that this pelvic "displacement" is objectively different from pelvic placement in normal, healthy populations, and how did they objectively link the widely variant forms of ill health that they describe to this displacement instead of any number of other things which are known to cause them?

"Differential Compliance Instrument in the Treatment of Infantile Colic" -- Again, two case studies. No controls. No blinding. No comparison of treatments, even. What actually worries me most about this particular study, is that it purported to test -- on INFANTS! -- whether a mechanical, computer-controlled manipulation was safge. They concluded "yes" -- and what monitoring did they do for mechanical damage to the infant? What exactly would they have done, how would it have been dealt with, if the answer had been unequivocally "no", as with the infants who have died after cervical manipulation? See, this is why real medical research has IRB reviews.

"Chiropractic Management of an Infant Experiencing Breastfeeding Difficulties and Colic" -- Ok, frankly, this one disturbs me, even more than the last. Here we have a case-study of an infant with feeding problems, rash and evidently pain (indicated by crying). IT IS TREATED WITH UPPER CERVICAL MANIPULATION, of the type which has been quite conclusively linked with apnea and even infant death by other research [*see below]. It quiets down. What indication do we have here that the infant has not been quieted by inducing apnea (breathing interruption), and the real symptoms resolve through simple time healing what was in all likelihood an illness?

"The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic" -- at least there was a pass at some form of experimental design, here. Problems: no non-treated control, no placebo control (say by "sham" mainipulations, or simple massage), undefined parameters (how are "normal range of motions" in 2-10 week old infants? How are these measured? I want *objective details*), and I would like to see a larger sample size to be able to make a good distinction between real effect and "noise" in a small sample, too.

"Chiropractic Care of Infantile Colic: A Case Study" -- Interesting that all I can find are either references in later chiropractic papers or the abstract up on a chiropractic website. I cannot find either the article **or the journal** in PubMed or any of the other medical index sites I usually use. It is a single case study, beyond that, it doesn't seem to have a lot of currency in mainstream medical literature. If you have a source for this journal article, please do share, anyone.

"
"Chiropractic Management of an Infant Experiencing Breastfeeding Difficulties and Colic" -- Ok, frankly, this one disturbs me, even more than the last. Here we have a case-study of an infant with feeding problems, rash and evidently pain (indicated by crying). IT IS TREATED WITH UPPER CERVICAL MANIPULATION, of the type which has been linked with apnea and even infant death by other research [*see below]. The infant quiets down. What indication do we have here that the infant has not been quieted by inducing apnea (breathing interruption), and the real symptoms resolve through simple time healing what was in all likelihood an illness?

"The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic" -- at least there was a pass at some form of experimental design, here. Problems: no non-treated control, no placebo control (say by "sham" mainipulations, or simple massage), undefined parameters (how are "normal range of motions" in 2-10 week old infants? How are these measured? I want *objective details*), and I would like to see a larger sample size to be able to make a good distinction between real effect and "noise" in a small sample, too.

"Chiropractic Care of Infantile Colic: A Case Study" -- Interesting that all I can find are either references in later chiropractic papers or the abstract up on a chiropractic website. I cannot find either the article **or the journal** in PubMed or any of the other medical index sites I usually use. It is a single case study, beyond that, it doesn't seem to have a lot of currency in mainstream medical literature. If you have a source for this journal article, please do share, anyone. I found the website for the journal, which is "published quarterly by the ICA Council on Chiropractic Pediatrics", but I am absolutely unwilling to subscribe to it in order to get access to its articles.

"Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases" -- A *prospective* study. No controls. No blinding. Outcome as far as I can tell assessed solely by analysis of maternal diaries by the chiropractors for "satisfactory results".

Seriously, what I would be looking for in any of these is an indication that this chiropractic manipulation is significantly different from or better than simple massage of the infant, for example. Do we have that? No. None of these so far are performing tests which would indicate that chiropractic manipulation is better than or different from placebo, confirmation bias, or coincidence. They're not "fixed" -- they're bloody RUBBISH. Nothing here would convince a skeptical non-chiropractic doctor, and there is a good reason for that.

But let's see what happens when independent physicians do a controlled, properly blinded study:

Olafsdottir E, Forshei S, Fluge G, Markestad T. "Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation." Arch Dis Child. 2001 Feb;84(2):138-41. http://adc.bmj.com/cgi/content/full/84/2/138

CONCLUSION---Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.

-------------------------
*Studies linking apnea and worse to chiropractic manipulations of infants:

Brand PL, Engelbert RH, Helders PJ, Offringa M. "Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)" [In Dutch] Ned Tijdschr Geneeskd. 2005 Mar 26;149(13):703-7.

..."Pooled analysis of two randomised clinical trials on the effects of chiropractic in infantile colic showed no statistically significant difference between active and control treatments. In addition, we found that 22% of infants showed short episodes of apnoea during manual therapy of the spine, and that one case has been described in which such apnoea resulted in death. CONCLUSION: Given the absence of evidence of beneficial effects of spinal manipulation in infants and in view of its potential risks, manual therapy, chiropractic and osteopathy should not be used in infants with the KISS-syndrome, except within the context of randomised double-blind controlled trials."

L. E. Kocha, H. Biedermannb and K. -S. Saternus "High cervical stress and apnoea" Forensic Science International
Volume 97, Issue 1, 12 October 1998, Pages 1-9

L. E. Kocha, H. Kochb, S. Graumann-Bruntc, D. Stolled, J. -M. Ramireze and K. -S. Saternus "Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants" Forensic Science International, Volume 128, Issue 3, 28 August 2002, Pages 168-176

And the description of one death:
http://anaximperator.wordpress.com/2009/05/07/infant-dies-after-cranios…

I would also reference Maurizio Paciaroni and Julien Bogousslavsky, "Cerebrovascular Complications of Neck
Manipulation" Eur Neurol 2009;61:112â118 DOI:10.1159/000180314

...Chiropracty has a lot to answer for. Trying to shift the focus off onto conspiracies of "Big Pharma"? Not good enough. And for evidence of efficacy, y'all really need to come up with something better than anecdote.

Ho hum....no surprise from this poster........obligatory whine............the research is no good.
Yip, heard it all before.

Now go back and re-read this perfectly reasonable research properly...and no further comment until you do so...reminds me of somebody...Oh yes,Singh the layman..a particle physicist with a unrehearsed opinion on everything....

Helllp.

Sorry for the typos. And, "...(how are "normal range of motions" in 2-10 week old infants? How are these measured?" should be "...(how are "normal range of motions" in 2-10 week old infants DETERMINED? How are these measured?"

...Oh, and I didn't make clear, I do know of another infant which died after cervical manipulation. I just don't have the reference here, it is on my work computer.

So, "dr" Mike, in other words, the legitimate criticisms of WHY the research is no good pass you by entirely; you feel free to ignore all of them. You will ignore all the flaws in the "research", and will only answer "criticisms" if they aren't criticisms of the methodology or conclusions? And not a single comment on the fact that in studies where there were placebo controls and the parents were blinded as to what treatment the infant received, there was no difference in outcome between chiropracty and placebo? No comment on the studies showing harmful outcomes from cervical or spinal manipulation of infants? You'll just feel free to act as if those don't exist? Why?

Yah. Done. ...You do know that these boards are full of science-literate people who can see this for precisely what it is, yes?

These boards are full of Singh lookalikes who see precisely only what they want to see........sheep another words.
Now "mr" luna.....get working on these references......please not that chiropractic has an overwhelming amount of research into this particular spinal pathology AND WE Have NOT EVEN TOUCHED THE OSTEOPATHIC LITERATURE(American osteopathic MD)........now GO.

Colic is defined as excessive, inconsolable crying of the infant. The management may range from parental attempts for baby positioning, stomach massage, maternal dietary changes for the breast fed baby, formula changes, chiropractic spinal and meningeal care, homeopathic remedies, herbal teas and allopathic drugs.

Peer Reviewed Journals:

Differential compliance instrument in the treatment of infantile colic: a report of two cases. Leach RA. J Manipulative Physiol Ther. 2002 (Jan);25 (1): 58-62
A PulStar Function Recording and Analysis System (PulStar FRAS, Sense Technology, Inc, Pittsburgh, Penn) device was used to administer light impulses (approximately 1.7 joules, which produced a 3 to 4 lb force) at each segmental level throughout the dorsal spine, with probe tips spaced 2 cm apart straddling the spinous processes. Crying was reduced by 50% after a single session of instrumental adjusting in a 6-week old girl and after 4 sessions in a 9-week old boy, according to colic diaries kept by the mothers. Average hours of uninterrupted daily sleep increased from 3.5 to 6.5 hours after a single session. Within 10 days (5 and 8 sessions, respectively), colicky behavior disappeared and average total daily sleep improved to 14.5 hours (an average increase of 4.5 hours). Results continued over a 30-day follow-up.

The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer, Wiberg JMM, Nordsteen J, Nilsson N J Manipulative Physiol Ther. 1999 (Oct);22 (8): 517-522
This is a randomized controlled trial that took place in a private chiropractic practice and the National Health Service's health visitor nurses in a suburb of Copenhagen, Denmark. One group of infants received spinal care for 2 weeks, the other was treated with the drug dimethicone for 2 weeks. Changes in daily hours of crying were recorded in a colic diary.
From the abstract: By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone groups compared with 2.4 hours in the manipulation group (P = 04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P=.004). From trial day 5 onward the manipulation group did significantly better that (sic) the dimethicone group. Conclusion: Spinal manipulation is effective in relieving infantile colic.
Chiropractic management of infantile colic, Andrea J. Hipperso, Science Direct

Abstract

Objective: To present two case studies in which the complete resolution of infantile colic and associated symptoms was achieved with chiropractic treatment. This case series supports the aetiological mechanism of an imbalanced autonomic nervous system, via somatovisceral reflexes secondary to regional cranial and spinal dysfunction. In addition, they provide support towards the birth process being a causative factor in the development of colic.
Subjects: The first case involved a 7-week-old male infant presenting with medically diagnosed colic, with associated reflux and disturbed sleep, all of which were persistent since birth. The second infant, aged 10 weeks, had suffered maternally diagnosed colic for approximately 1 month. Associated symptoms included some vomiting and asymmetry with breast-feeding. Both infants demonstrated many typical colic characteristics and had experienced birth trauma. Upper cervical, mid thoracic, sacroiliac and cranial dysfunction was recorded in both cases.
Methods: Each infant received diversified paediatric chiropractic manipulation to the areas diagnosed as dysfunctional. Treatment was provided over a 3-week period, though the intensity differed for the two infants.
Results: Complete resolution of all presenting symptoms was achieved in both instances.
Conclusion: These cases suggest a possible association between birth trauma; the development of cranial and spinal segmental dysfunction and consequential manifestation of symptoms of infantile colic. Secondly, they demonstrate chiropractic treatment successfully restoring correct spinal and cranial motion, with an associated resolution of symptoms.

Kinematic imbalances due to suboccipital strain in newborns. Biedermann H. J. Manual Medicine 1992, 6:151-156.

More than 600 babies (to date) have been treated for suboccipital strain. One hundred thirty-five infants who were available for follow-up was reviewed in this case series report. The suboccipital strain's main symptoms include torticollis, fever of unknown origin, loss of appetite and other symptoms of CNS disorders, swelling of one side of the facial soft tissues, asymmetric development of the skull, hips, crying when the mother tried to change the child's position, and extreme sensitivity of the neck to palpation. Most patients in the series required one to three adjustments before returning to normal. "Removal of suboccipital strain is the fastest and most effective way to treat the symptoms...one session is sufficient in most cases. Manipulation of the occipito-cervical region leads to the disappearance of problems...."
Infantile colic and chiropractic. Nilsson N Eur J Chiro 1985;33 (4) :264-65.
In this study (retrospective uncontrolled questionnaire) of 132 infants with colic, 91% of the parents reported an improvement, which occurred after an average of two to three adjustments, and within one week of care.

Infantile colic treated by chiropractors: a prospective study of 316 cases. Klougart N, Nilsson N and Jacobsen J (1989) J Manipulative Physiol Ther. 1989 (Aug);12 (4): 281-288

In this study, 73 chiropractors adjusted the spines of 316 infants (median age 5.7 weeks at initial examination) with moderate to severe colic (average 5.2 hours of crying per day). The infant's mothers were provided a diary and kept track of the baby's symptoms, intensity and length of the colicky crying as well as how comfortable the infant seemed. 94% of the children within 14 days of chiropractic care (usually three visits) showed a satisfactory response. After four weeks, the improvements were maintained. One fourth of these infants showed great improvement after the very first chiropractic adjustment. The remaining infants all showed improvement within 14 days. Note: 51% of the infants had undergone prior unsuccessful treatment, usually drug therapy.
Colic With Projectile Vomiting: A Case Study Journal Of Clinical Chiropractic Pediatrics, Van Loon, M; 1998 Aug; 3(1): 207-10

Objective: The purpose of this case study is to discuss the chiropractic care of a patient who presented to the author's office with a medical diagnosis of colic, with additional projectile vomiting. The proposed etiology, the medical approach to colic, and the chiropractic care for this infant is detailed. Also examined is the connection between birth trauma and non-spinal symptoms.
Design: a case study. Setting: private practice. Patient: a three-month-old Caucasian male presenting with medically diagnosed colic. Symptoms had been increasing in severity over the previous two months despite medical intervention.
Results: the resolution of all presenting symptoms within a 2-week treatment period is detailed. Care consisted of chiropractic spinal adjustments and craniosacral therapy.
Conclusion: this case study details the chiropractic management of a three-month-old male with a medical diagnosis of colic who also exhibited projectile vomiting. Complete resolution of all symptoms was achieved. Proposed cranial and spinal etiologies are discussed, as well as the connection between birth trauma and non-spinal symptoms.
http://www.sotousa.org/frames.html
Case Studies:

A six week old baby with colic. International Chiropractic Pediatric Association Newsletter. May/June 1997.
Six week baby with colic could not sleep for more than one hour at a time and could not hold food down. C1 subluxation was located and adjusted. After first adjustment infant fell asleep before leaving the office and slept for 8 hours straight. The baby gained two pounds in one week. The child was seen three times per week for two months thereafter once a week. The colic symptoms never returned.

Chiropractic management of an infant experiencing breastfeeding difficulties and colic: a case study. Sheader, WE Journal of Clinical Chiropractic Pediatrics, Vol. 4, No. 1, 1999.
A single case study of a 15 day old emaciated Hispanic male infant experiencing inability to breastfeed and colic since birth, crying constantly, "shaking, screaming, rash, and vomiting during and after feeding." The baby also had "increased distress" 30 minutes after feeding and had excessive abdominal and bowel gas since birth. The mother reported the infant was given a Hepatitis B vaccination within hours after birth.
Examination: During the examination the infant continuously cried, with high-pitched screams, and full-body shaking. Child had a distended abdomen with excessive bowel gas.

Chiropractic Adjustment: Adjustment was made to the first cervical vertebra. It was followed by significant reduction of crying, screaming and shaking. The mother commented on the "quietness" of her baby. On the second visit, two days later the mother commented, "This is a completely different baby". The vomiting before and after feeding had ceased. Another adjustment was given. By the third visit, a "significant decrease of symptoms" was reported and complete remission of abdominal findings. Baby had been successfully breastfeeding since last visit. No adjustment was given. By the fourth visit 3 days later, the baby had been symptom free for 5 days at which time he received another Hepatitis B shot with the return of all symptoms to a severe degree. Adjustment was given but there was no reduction of symptoms. The patient was adjusted three more times over the next week with minimal reduction in symptoms. By the eighth visit, eight days after receiving the vaccination the child began to show marked improvement and by the 11th visit, no symptoms were noticed and no adjustment was given.

Colic with projectile vomiting: a case study. Van Loon, Meghan. J of Clinical Chiropractic Pediatrics. Vol. 3 No. 1 1998. 207-210.

From the abstract: The purpose of this case study is to discuss the chiropractic care of a patient who presented to the author's office with a medial diagnosis of colic with additional projectile vomiting. The proposed etiology, the medial approach to colic, and the chiropractic care for this infant is detailed. Also examined is the connection between birth trauma and non-spinal symptoms.
Patient: A three-month-old Caucasian male presenting with medically diagnosed colic. Symptoms had been increasing in severity over the previous two months despite medical intervention.

Results: the resolution of all preventing symptoms within a 2-week treatment period is detailed. Care consisted of chiropractic spinal adjustments and craniosacral therapy.

Conclusion: This case study details the chiropractic management of a three-month-old male with a medical diagnosis of colic who also exhibited projectile vomiting. Complete resolution of all symptoms was achieved. Proposed cranial and spinal etiologies are discussed as well as the connection between birth trauma and non-spinal symptoms.

Chiropractic care of infantile colic: a case study. Killinger LZ and Azad A. J of Clinical Chiropractic Pediatrics. Vol. 3 No. 1 1998. Pp. 203-206

This is the study of an 11-month-old boy with severe, complicated, late onset infantile colic. The infant had been unable to consume solid foods for a period of four months, and suffered from severe constipation. In addition, this subject demonstrated extreme muscular weakness and lack of coordination. The baby was unable to crawl, stand or walk and was greatly unresponsive to his surroundings.

[Note: child had been under medical care at the Rochester Medical Clinic, with no improvement in his condition.] Following upper cervical specific chiropractic adjustments for a subluxation of the first cervical vertebrae (atlas) there was immediate improvements in muscle strength, coordination, responsiveness, and ability to consume solid foods without vomiting.

Chiropractic management of an infant patient experiencing colic and difficult breastfeeding: a case report. Cuhel JM, Powell M, Journal of Clinical Chiropractic Pediatrics Vol. 2, No. 2 1997. P. 150-154.

A twelve-day-old male was presented for chiropractic examination and treatment by his mother. The mother related difficulty in feeding on the right breast. She also stated that he seemed "fussy" and had been producing excess bowel gas. Palpation and motion studies revealed the occiput having a limited range of motion. The atlas was found to be fixed.with infant showing visible signs of distress on palpation of the right cervical soft tissue structures.
A chiropractic adjustment was performed to the atlas: right atlas transverse using infant toggle-recoil technique. The mother breastfed the infant at the office immediately following the adjustment with no problems nursing on the right breast. Over the course of this patient's care, additional chiropractic adjustments were performed. This course of treatment was met with limited success. This prompted the mother to add that an injection of Depo-Provera (contraceptive injection) had been administered 24 hours after the delivery. The parent was advised that this injection may have been a contributor to the infant's problem. Acting on this advice the mother did not receive the next injection as scheduled. Nutritional supplementation was utilized, and adjustments were continued. The infant's pattern of breastfeeding and bowel function normalized.

Vertebral subluxation and colic: a case study. Pluhar GR, Schobert PD. J of Chiropractic Research and Clinical Investigation, 1991;7:75-76.

From the abstract: A case study of a three-month-old female suffering from colic with resultant sleep interruption and appetite decrease is presented. Child received three adjustments with two weeks between adjustments (T-7 and upper cervical area were areas worked on.) Symptoms of colic were relieved within the above brief period.

Birth Trauma Results in Colic. Krauss LL Chiropractic Pediatrics Vol. 2 No. 1, October, 1995

From the abstract: The objective of this case study is to document the effects of chiropractic on poor sleeping patterns in an infants through a difficult time in an infant's life. Many infants do not sleep well at night or nap time, and are then irritable throughout the day. These infants are often diagnosed as colicky. The term colic is a symptom commonly seen in infants under three months of age, characterized by paroxysmal abdominal pain and frantic crying. The mother, often as a reaction, is also irritable, exhausted, and, at times, depression and self doubt set in. Physical and emotional fatigue can make this time unbearable and bonding with child difficult. This is the study of a 9 1/2 month old female child with colic. The child was adjusted C1 on the right side (using an adjusting instrument) T4-T5 was manually adjusted and the sacrum was instrument adjusted. The following day the mother reported that the infant had slept through the night, a consistent 12 hours, and woke up happy and playful.

Additional Articles:

1) Chiropractic and Colic. World Federation of Chiropractic - May 1999.

A pilot study presented at the World Federation of Chiropractic's 5th Biennial Congress in Auckland, New Zealand, suggests that chiropractic care is superior to placebo for the treatment of infantile colic. A total of 30 infants, aged 0 to 8 weeks, were included in the trial. Fifteen infants received chiropractic spinal manipulation for two weeks. The remaining subjects received placebo ("sham" non-functional ultrasound). Based on parental reports at 1-month follow-up, the study's authors found "a statistically significant difference in the response to treatment by the experimental group as opposed to the placebo group."

2) "Chiropractic Care Conquers Colic" December 1998 issue of Country Living's Healthy Living, Page 53.

An inconsolable newborn finds comfort after six sessions with a chiropractor; Nicholas Roe tells the family story. When I Telephoned my doctor to ask if he thought it was safe (to see a chiropractor), he was ambivalent: Chiropractic would neither harm nor help. He told me that if it was colic, it would run its course in three months." To summarize the article: Following the first adjustment, the child was more reactive and colicky, but mom followed the instructions given her by the DC and the baby calmed right down. "We had five more sessions with Stephen. Each lasted 20 minutes and Lucy (the infant!) really seemed to enjoy them. It completely changed what was fast becoming a nightmare. I would like to recommend to everyone with a colicky infant see a chiropractor. It certainly worked for us.

You might also enjoy this article: Chiropractic Care found more Effective than Drug for Colic

Review more articles on Colic at Chiro.Org

Yes Luna.......having a bit of a struggle their buddy...

Have a nice day

Your new friend Dr Mike

Great, you are able to copy-paste abstracts. THAT DOES NOT ANSWER THE CRITICISMS OF METHODOLOGY. If you don't "get" why anecdotal "case studies" of non-blinded, non-controlled small numbers =/= experiments which eliminate observer bias and placebo effect, then your science illiteracy is such that we cannot help you.

Idiot. (No, that is not an "ad hom", it's just an insult. You've got that "perfect storm" of wilfull ignorance, arrogance, and patronisation going. The almost-sad part is, I don't think you have a hope of genuinely understanding why we aren't taking you seriously.)

Wow, Luna and Dr Aust, you have outdone yourself. Now you have directly quoted another blog, in which "Dr Aust" and "Dr Robinson" had the exact same conversation, with Dr Aust referring to Dr Robinson as a male, Dr Robinson saying "by the way, I am a female" and Dr Aust apologizing, saying that he didn't want to assume! Furthermore, you quote Dr Aust and Svetlana Pertsovich (another identity who appears to be the same as Dr Aust) by calling the blogger Dr Mike, "dr" Mike to insult his credentials. This is hilarious!

But, back to the attempts at scholarly discussion. . .

There would not be blinding or placebo components of a case study. It is a CASE STUDY. By definition, a case study is a write up of a situation that a doctor saw that he/she thought was interesting, unique, or otherwise worthy of writing up. This is how almost all research begins. A doctor does something, either it works or it doesn't work, it gets written up and later people want to know if it was an isolated incident or indicative of a common result. Usually, there are LOTS of case studies showing similar results before someone is willing to put in the time and money to do a larger study.

Furthermore, your rejection of research saying "the "researcher" performing the treatment performs such treatments for a living. Concludes that the treatment helps. Oooo, wotta surprise." is just a parroting of Dr Aust (is it parroting if you are quoting yourself?) and others who are just trying to discredit research they don't agree with. Do we reject research on arthroscopic knee surgery because it is done by orthopedic surgeons? Do we reject research on core strengthening programs because it is done by physiotherapists? Why, then, should we reject research on chiropractic interventions just because it was done by chiropractors? Who else is going to do it? If you look through the research on chiropractic injuries, you find that frequently the injury associated with "chiropractic treatment" is being caused by non-chiropractors who do a manipulation that they are not trained to do and cause harm. See, for example:

Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. J Neurol. 2006 Jun;253(6):724-30. Epub 2006 Mar 6. - In this article, they found that "chiropractic treatment" caused injury in the 36 patients in the last 3 years in Germany, out of 10 million patients accounting for 125 million chiropractic visits in the "western world" in the last decade. The injurious "chiropractic treatment", in this case was delivered by 18 orthopedic surgeons, 5 physiotherapists, 1 neurologist, 1 homeopath, 2 general practitioners, and only 4 chiropractors. To complicate this, there is not yet regulation on chiropractic in Germany, and no protection of the title. My cousin can go to Germany and say that he is a chiropractor with no legal ramifications, even though he is a chef. I could go, even Luna could go, and it is pretty clear that "she" knows nothing about chiropractics. Even if we assume that these were "real chiropractors" who actually went to a chiropractic school, only 11% of this "chiropractic injury" was actually caused by chiropractors! This is not saying "doctors bad, chiropractors not so bad in comparison", it is stating an obvious fact. My orthopedic surgeon was good, amazing really, and I haven't had any problems with my knee since he did his work. Despite his excellent work, however, I wouldn't go to him for my root canal, or my laser eye surgery, and I certainly wouldn't go to him for a chiropractic adjustment. Why? Because that is not what he is trained to do.

Stroke following chiropractic manipulation of the cervical spine. J Neurol. 1999 Aug;246(8):683-8. In this one, they talk about the 10 patients who had VAD or CAD following "chiropractic manipulation of the cervical spine" and then about "chiropractic cervical spine manipulations, which have been identified as one of the major causes" of VAD/CAD. Reading the results, however, you see that "The manipulations were performed outside our institution by orthopedists in seven patients, a physiotherapist in one, and health practitioners who are not physicians in two" The chiropractic maneuver type was described by the patients since medical documentation of it was not available in any case". So they are calling it "chiropractic" even though NONE of the treatments were provided by chiropractors, and they are basing that it is "chiropractic" on a patient's description of the movement that was done!

Now, let us look at some of your articles.

Olafsdottir E, Forshei S, Fluge G, Markestad T. "Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation." Arch Dis Child. 2001 Feb;84(2):138 - yes, this article concluded that, "Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic." When you read the methods, however, you see that there was a 70% improvement in the treatment group with a 60% improvement in the placebo group. True, this is not statistically significant in a group of 86 babies, but with a larger sample size with similar results, it would have been significant. Even the study itself recommends a larger sample size.

Brand PL, Engelbert RH, Helders PJ, Offringa M. "Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)" [In Dutch] Ned Tijdschr Geneeskd. 2005 Mar 26;149(13):703-7. - It is clear that you did not read the article that was in Dutch, but just the translated abstract. Even there, however, it says that, "No clinical trials were found that evaluated the effects of manual therapy or osteopathy on either the KISS-syndrome or its symptoms.". The references for article itself, however, if you bothered to follow up, show that the "one case has been described in which such apnoea resulted in death" was not a case in which a chiropractor was doing the treatment! This is an understandable misunderstanding, but one that could be cleared up easily if one were to read the first few lines and realize that this study attempted to pool the results of chiropractic, osteopathy, and general manual therapy into one.

L. E. Kocha, H. Biedermannb and K. -S. Saternus "High cervical stress and apnoea" Forensic Science International. - This one is great, and again, from Germany. I especially like the quote "Of the infants that died of SID, 60% were found to have a statistically significant difference in the diameter of their two vertebral arteries" Anyway, this study was a study of SIDS that was predicated on the unproven assumption that, "The gentle impulse the chiropractor can administer by manipulation enables one to examine the effects of mechanical irritation of the atlanto-occipital region (CO/2) which can occur in the normal course of infancy." What makes it even better is that the facility in which the "gentle chiropractic impulse" was delivered, the Facharzt für Chirurgie, is an outpatient surgical center with no chiropractors on staff. Can I be certain that they didn't hire a chiropractor to come in for this study? No, I can't. Let's be honest, however, it is pretty unlikely, and if they actually went that far, they would have been proud of their thoroughness and most likely mentioned it somewhere.

L. E. Kocha, H. Kochb, S. Graumann-Bruntc, D. Stolled, J. -M. Ramireze and K. -S. Saternus "Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants" Forensic Science International, Volume 128, Issue 3, 28 August 2002, Pages 168-176. This article has some author overlap with the previous article. Here we see a general practitioner at the surgical center, a medical candidate from the University, a psychologist who specializes in language disease, an anesthesiologist, an anatomy instructor from the US, and someone from the institute of Legal Medicine. Once again, you have people untrained in a technique delivering it and then making a conclusion based on that. I was a pretty good doctor, but I would have had bad results, too, if I had been performing heart transplants, because I wasn't a cardiac surgeon.

Maurizio Paciaroni and Julien Bogousslavsky, "Cerebrovascular Complications of Neck Manipulation" Eur Neurol 2009;61:112â118 DOI:10.1159/000180314. This one is a literature review, and not a case study or clinical trial, and it starts out by introducing neck manipulation as " commonly used by osteopaths, physiotherapists and physicians." I also enjoyed the statement, " it is still controversial whether manual therapy of the cervical spine is truly associated with an increased risk of cervical artery dissection" and " In fact, practitioners of manipulation, irrespective of their professional training (medicine, osteopathy, physical or chiropractic therapy), have consistently claimed that the risk of stroke after manipulation is so small that it should be considered insignificant".

The best part is, " A recent case-control and case-crossover study confirmed an association between chiropractic care and vertebral artery dissection resulting in vertebrobasilar stroke [57]. But this latter study also found a strong association between primary care physician visits and subsequent vertebrobasilar stroke. The authors hypothesized that patients with head and neck pain due to vertebral artery dissection seek care for these symptoms, which precede more than 80% of vertebrobasilar strokes [58]. Since it is unlikely that primary care physicians can cause stroke while caring for these patients, the authors assumed that the observed association between a recent primary care physician visit and vertebrobasilar stroke represents the background risk associated with patients seeking care for dissection-related symptoms that eventually lead to vertebrobasilar stroke. Because the association between chiropractic visits and vertebrobasilar stroke is not greater than the association between primary care physician visits and vertebrobasilar stroke, the authors concluded that there was no excess risk of vertebrobasilar stroke from chiropractic care." And the conclusion, " Further research is required to examine both the possible benefits and harms associated with cervical spine manipulation."

Hey Luna, did you read past the introduction in this last one? Stop wasting our time.

Good lord, am I still being accused of being a sock-puppet?

Fascinating. What IS this other blog, anyway? Since I don't know the conversation in question, I don't know what level of overlap there is with Dr. Aust. One thing I would like to point out, though, is that to medically and scientifically literate people, the same things are very likely to appear as rubbish and anecdote. Pointing this out is no more "copying" than multiple people pointing out that the sky is blue.

Anyway. I don't have time to pick this apart in depth, as I have an actual day job to pay attention to now, but I would like to raise a couple of quick points:

1. The collection of anecdotes above is an interesting indication that properly controlled/blinded studies would be useful. There have now actually been 2 properly blinded/controlled studies of chiropractic manipulation for "colic", both of which indicated that it is no better than placebo. The key aspect is parental belief; where the parent(s) are kept blind to the treatment, no significant long- or short-term difference. Where the parent(s) are aware of what treatment the infant receives, they believe there has been improvement with chiropractic intervention. If one were confident of the safety of the intervention (which personally I'm not), one might recommend visiting the chiropractor to make the parents feel better...which is, nonetheless, a placebo effect. I'd personally argue it's a dishonest way to lighten people's pockets, but hey, whatever.

2. You are quick to blow off the Forensic Science International papers. I guess you didn't read the methods section? The studies were done because of observations made of infants in chiropractic care, and observers were stationed with chiropractors to monitor infants while being treated for diagnosed KISS ("For the chiropractic therapy the infants were positioned on their back while the chiropractor was sitting perpendicular to the childâs head. ...") in the case of the second paper, and "The aim of this study was to investigate vegetative reactions in infants after mechanical irritation of the suboccipital region" in the first paper (where the first two authors have orthopedic/chiropractic training, as well). But ignore the qualifications, the precise aims of the papers, the fact that they focus on the very infants most likely to be brought for chiropractic care, or the methods; they disagree as to the safety of the procedure, which you believe in, so ignore them, right?

3. For "Cerebrovascular Complications of Neck Manipulation" -- all I can say is, wow, I don't think *you* read it. The authors address the fact that head and neck pain is both the cause of the patients seeking medical treatment whether chiropractic or not, and indicative of the risk of subsequent stroke, which is why there is also a rate of stroke after seeing physicians who don't even touch their neck; the issue, however, is the *elevated* risk of stroke with neck manipulations, where they reach a different conclusion than Lee et al.:

To date, there has been no reported relationship between
the type of manual therapy and risk of stroke, as
stroke symptoms have been reported to begin immediately
after the first manipulation or several treatments.
Some authors have found no relation between the number
of chiropractic manipulations and the incidence of
cervical artery dissection. In patients with neck manipulation, strokes have been reported to occur after any form of standard cervical manipulation technique including
rotation, extension, lateral flexion and non-forced and
neutral position manipulations.

[emphasis mine]
This is illustrative of the issue that ANY stretching or compression of the neck in vulnerable patients represents risk, and that the risk is idiosyncratic -- meaning that screening for exclusion is likely to be pointless.
Furthermore:

Conclusions and Key Points
(1) There is little evidence on the specific beneficial therapeutic effects of spinal manipulation.
(2) Evidence shows an association between spinal manipulation and mild adverse effects as well as with serious complications including dissection of cervical arteries most commonly involving the vertebral arteries.
(3) Specific risk factors for cerebrovascular complications
such as cervical artery dissection and stroke related to
spinal manipulation have not been identified yet. For
this reason any patient may be at risk, particularly
those younger than 45 years.
(4) Patients undergoing spinal manipulative therapy
should be informed of the risk of stroke or vascular
injury from this procedure.
(5) The diagnosis of a cerebrovascular complication
should be seriously taken into consideration in patients
presenting with recent onset vertigo and loss of
balance, and anamnesis should inquire about any recent
spinal manipulations.
(6) Further research is required to examine both the possible benefits and harms associated with cervical spine
manipulation.

Basically, you are still trying to sell us on unproven and potentially very risky "therapies" with a great deal less evidence behind them than the majority of mainstream therapies. Sorry, but it's STILL crap to compare them.

Point 1 - you repeat your point from a previous study, which unfortunately doesn't change the situation and make it right. I agree that more research is necessary, but you are wrong when you claim that the lack of sufficient research is a condemnation of the practice.

Point 2 - I did read the methods, and I checked out the background of the authors. I am objecting to the fact that so-called chiropractic treatment is being delivered by individuals NOT trained to provide this care. None of the authors have received chiropractic training, and your claim that they have received "orthopedic / chiropractic" training is both completely unsupported and a deliberate lie. I'm sorry, but I am not allowed to pull someone's tooth out and call myself a dentist, so why should someone who is clearly NOT a chiropractor be allowed to say they are delivering chiropractic treatment? We do not allow this in any other section of scientific literature, and any attempts to defend it here "smacks of someone with an agenda".

Point 3 - The study found that, statistically, and in a reasonable sample size, there was no statistical difference in the rate of stroke between chiropractors and doctors. Since, as you logically claim, the doctors would NOT have been touching the necks of their patients and nearly all of the chiropractors would have been, the conclusion which was logically drawn is that the touching of the neck did NOT elevate the risk of stroke. Also, I did read the conclusions, but was unable to find where they were supported in the article, indicating poor quality. They say there is no evidence for therapeutic benefit, but did not discuss benefit in the literature review; they discussed safety. Also, as we have covered before, saying that there is "no evidence" is a lot different than saying that there "is evidence that there is no therapeutic benefit." They say there is an association between manipulation and adverse effects, while neglecting to mention that their major study on this found equivalent association with other practitioners, too. The third says that because we don't know what risk factors will predispose people to a stroke, so we should warn them that manipulation can, and the fourth says people should be warned. Well, in today's society, where we need to warn people that they should't put plastic bags over their babies' heads or that hot coffee can burn you, I suppose this is true. Number 5 is a big "duh" and number 6, as we say, says that more research is needed before we can say what are the possible benefits and risks.

I don't know if chiropractic treatment is safe or beneficial, and to be honest, it doesn't effect me at all in any way. I never had so much of an ego when I was in practice that the idea that someone else could do something I couldn't made me angry. If people get better from what I could do for them, great. If people get better because they saw a chiropractor, that's good, too. Until there is evidence that says that chiropractic DOESN'T work, I'm not going to jump to the conclusion that it's bad, and I am certainly not going to make it my passionate life's work to turn everyone else against it, too.

Some personal things from me. . . I do find it offensive and reprehenisble, when people attempt to twist data or tell half-truths, or even when they deliberately lie in order to support their own agendas. Oh, and I find it offensive when people are incredibly moronnic, whether it is intentional or not.

Thank you Cochrane for at least bringing rationality and sanity to this debate with the sheep......
Luna...thank you for your insults,they are usually a measure of the man or woman...you do not further your case particularly simply by being rude and insulting.Although it does make you stand out as a person who struggles when presented with the evidence....Wellll thats your problem what I find most annoying is that your stupidity is actually dangerous especially as you sheep feed of each other.....

Oh' and to quote Cochrane... "Oh, and I find it offensive when people are incredibly moronnic, whether it is intentional or not".

Luna I choose to accept your view as simple unintentional stupidity....a simple mistake.

Thank you
Have a nice one.

Cochrane Reviewer seems to be seeing conspiracies and false identities where none exist. CR, is it that surprising people disagree with you? You seem to take it very personally when they do. It is a commonplace piece of Internet Advice that you should stay off the blogs if you are easily "wound up".

It is always amusing to find oneself accused online of being other people who one actually knows (either virtually or in the "real world"), but CR's accusing me of being Svetlana Pertsovich was so funny it brought tears to my eyes. This is mainly because Svetlana Pertsovich, a Russian scientist who is a well-known presence on the Badscience blogs, was once convinced - and insisted at length over at my blog - that I was Prof David Colquhoun.

While we're discussing who is or isn't a real person, Dr Robinson the chiropractor from "the other thread" (which is over at Respectful Insolence here) is certainly a real person, too. I know this because she emailed me, and we corresponded once or twice. I even know where she works, as she told me that too, though I won't repeat it here.

Anyway, I know it is a waste of time to have the same argument more than once, but sometimes I can't stop myself.

Incidentally, for aficionados of internet conspiracy, it should be obvious that the most reliable guide to whether identities posting online are "sock puppets", apart from the IP addresses which the blog owner can see, is the WRITTEN STYLE. It is a bit like spotting student plagiarism, where wildly different styles in the same essay (terse science-ese one minute, Ali G the next) leads one to suspect bits are copied from somewhere else. You can get computer programmes to do it, but a reader's "nose" is a pretty good detection tool.

-------------------------------

For info, the discussion with Dr Robinson was mostly about under what circumstances a chiropractor should call themselves "Dr". As I recall, I was contending that saying "Dr", without making clear it was "Dr of Chiropractic", was misleading. In the UK, it is against the chiropractors' own ethics codes, and indeed probably illegal, if it is done in a setting where a patient would likely assume "medical Dr". Thus the email in the post above from the McTimoney lot:

4. If you use business cards or other stationery using the 'doctor' title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.

It is my opinion that chiropractors make a great pitch of "claiming the cloak of authority", and use this extensively as a way of claiming validation for all of what they do. This is my opinion from reading their journals and letters (especially their responses when they are criticised), from following their reaction to the Singh case and the resulting "Quacklash", and from my experiences discussing things with them online. But hey, like I say, it's just an opinion. Everyone's got one.

Next: re. Dr Mike's post listing a great slew of purported evidence for chiropractic, I had actually already discussed a lot of this in a comment above without listing out the papers by title:

-----------------------------------------------------

There are some older observational and "survey-style" studies, reported in the chiropractic literature, that report favourable outcomes. These presumably have considerable selection, observation, and reporting biases...
[This description covers most of Dr Mike's references, and would include Klougart et al. 1989, the large 316-patient observational study which is the paper most often offered by chiropractors to justify their treating of colic, and which Luna has already discussed]

Then there is a 50-participant controlled trial with slightly positive outcomes, but less than perfect blinding.
[This is Wiberg et al. 1999]

Then there is a 100-patient randomized controlled trial with a blinded observer that reports absolutely no effect.
[This is Olafsdottir et al. 2001]

These studies have been systematically reviewed - notably by a duo consisting of a chiropractic researcher and a paediatrician - and the conclusion was that the best evidence pointed to the view that there was no efficacy of chiropractic for colic.

----------------------------------------------

So hopefully you can see that I actually have looked at the literature.

It looks to me like just what you would expect for a placebo treatment.

Finally, Dr Mike wrote:

Singh made a fool of himself as a layperson commenting on matters he knows nothing about he stirred the anger of a noble very well organised and internatinally established profession...which as a last resort had to give the big mouth a public thrashing....let that be a lesson to others who feel they can publically say what ever they damn well please whether right or wrong.

Ho hum. Invective and bullshit - not a surprise given the tone of Dr Mike's previous comments on the thread. Singh was paraphrasing the book he co-wrote with Edzard Ernst, a medically-qualified Professor who is perhaps the world's leading authority on assessing the evidence for (and against) complementary therapies. Ernst also once headed a large Department of Rehabilitation Medicine in a famous European University (the University of Vienna), and trained in various complementary therapies including spinal manipulation.

Now, would you think he might know something about all this stuff? Surprise surprise, he agrees with Simon Singh, as you can read here.

Anyway, your last paragraph, with pomposity in every line and the threat at the end, tells us where you are really coming from, Dr Mike. You are, no doubt, a credit to the chiropractic profession.

There is no threat in anything I report here...however a statement of fact may indeed be intimidating.....
As for McTimony..they are not doctors of chiropractic and never have been....they are a something else..nobody knows what......
As for the two stooges SINGH and Ernst...both are well known even within palace circles as being, shall we say irregular commentators on just about everything they know nothing about.........

Now Aust..enough of the cheeky posts...go get your head straight and annoy somebody else.....check out spontaneous combustion,that should keep you on the boil for a month or two...now GO.

Your new friend and clinical mentor Dr Mike.

...I do find it offensive and reprehenisble, when people attempt to twist data or tell half-truths, or even when they deliberately lie in order to support their own agendas. Oh, and I find it offensive when people are incredibly moronnic[sic], whether it is intentional or not.

Goshdarn it, I just had that irony meter repaired, and there it goes again.... :-/

Again, still at work -- but would merely like to note in passing:

(a)that ignoring how the only properly blinded/controlled studies find no effect beyond placebo does not make that point invalid, or invisible to everyone else. And you seem to be claiming some form of medical experience; are we supposed to believe that you have never seen "promising" treatments in anecdote fail to pan out under controlled studies?

(b)that the authors of "Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants" specifically acted as monitors of the chiropractors (i.e. not themselves!) performing treatments, and that the author H. Biedermann of "High cervical stress and apnoea" is in fact Heiner Biedermann, a chiropractic/surgical specialist in "manual medicine and pain with a focus on children and adolescents" with extensive experience with/training in caring for KISS children, and author of Manual therapy in children. Basically, your argument that there is no-one "qualified" in these papers is bullshit.
and

(c)that "dr mike" is getting precisely the response that his regurgitated copy-pasta, conspiracy-driven dismissal of medical science, and repetitive insults of everyone else deserves (actually, that's not true; I've wasted far more time on patient and substantive responses than his nonsense deserves) -- but I find it fascinating and telling that you are not calling him out on any of his behaviour...

And, seriously; if you cannot bring yourself to accept Paciaroni and Bogousslavsky's summary of why they reached their conclusions, read the papers they reference. This should not be something you have to be TOLD to do.

And if you honestly don't have a clue how your sanctimonious bs quoted above applies both to yourself and "dr mike", then, sweet jumping jesus on a pogo stick, I don't see the point of arguing with you. "Against stupidity, the gods themselves contend in vain."

"Dr" Mike, how sad that your entire argument consists of repeating things you don't understand and insulting your claimed "friends". Are you aware of this and just trolling for fun? Neither big nor clever; too many uneducated 10-year-olds manage that for you to be able to take much pride in it, I would have thought.

Luna buddy...you are wounded. But hey you get a B+ for "both to yourself and "dr mike", then, sweet jumping jesus on a pogo stick". Even I had to smile at that one...well done.

Now the truth hurts Luna...you can wriggle scream and squirm all you want....You think chiropractors are uneducated weekend clinical warriors......This Singh silliness has done wonders to open the eyes of the nation to just how serious a profession chiropractic actually is....
And remember after med and dentistry, chiropractic is the third largest primary health care profession in the world.......Yes Luna it shakes you right down to your little pink cotton socks.

Simple but true.

Your new friend and clincal mentor Dr Mike.

And remember after med and dentistry, chiropractic is the third largest primary health care profession in the world......

To which there is only one response, really:

- Be afraid. Be VERY afraid.

*snort*

...yes dear, if it makes you happy, you just go on telling yourself that.

Aust buddy...nothing to be afraid of unless you feel you can shoot your mouth having failed to read the research and like to denigrate a noble profession...be given numerous chances to retract a stupid statement to which you refuse then find yourself guilty of big mouthism to which you try to cover your tracks by pretending this is a free speech issue as opposed to a ill judged set of comments aimed at seeking public notoriety and gaining advances for the next book............Hell the guy is not even clinical
This is the CV of the guru at whose alter you are prostrate worshipping...................sad but true.

Luna buddy...or is it buddy'ess I am finding it hard to be vexed with you as you have shown a sense of humour which Aust may wish to mimic...........

Come on, this is not the end of the known world......
Its merely a rift caused by a silly boy which has essentially been confined to history...the case is closed.
Now Aust and Luna THREE CHEERS FOR CHIROPRACTIC HIP HIP...go

Aust buddy...nothing to be afraid of unless you feel you can shoot your mouth having failed to read the research and like to denigrate a noble profession...be given numerous chances to retract a stupid statement to which you refuse then find yourself guilty of big mouthism to which you try to cover your tracks by pretending this is a free speech issue as opposed to a ill judged set of comments aimed at seeking public notoriety and gaining advances for the next book............Hell the guy is not even clinical
This is the CV of the guru at whose alter you are prostrate worshipping...................sad but true.

Luna buddy...or is it buddy'ess I am finding it hard to be vexed with you as you have shown a sense of humour which Aust may wish to mimic...........

Come on, this is not the end of the known world......
Its merely a rift caused by a silly boy which has essentially been confined to history...the case is closed.
Now Aust and Luna THREE CHEERS FOR CHIROPRACTIC HIP HIP...go

Hmm. Well, you just carry on thinking that, Dr Mike. In your personal Alternative Reality it may well be true.

I think myself that anyone reading through all your posts here is unlikely to come away with their respect for chiropractic and chiropractors enhanced.

But like I say, maybe that's just me.

What would you like me to do Aust buddy....offer you my support....show deference to your twisted point of view.
I suspect what is more likely is that the average viewer will see the logic of the chiropractic position through the reasonable views I have offered then contrast and compare those with the limp wristed insults and circular argument
proffered by the ever skeptical Singhite twitching laypersons represented by yourself et al.

Sorry I can not join you on your particular plain of zealot anti-chiropractic dementia however we need not fall out over mere detail...don't you agree.

Have a nice one.
Your new friend and clinical mentor.

Dr Aust,

Clearly you have misunderstood, and perhaps that is reasonable. I do not see your posts or any other as a conspiracy, but more as a bit of a joke. That is what I mean when I say something is "hilarious".

Luna,

Thank you for your attempts to be condescending, but they are misplaced. I have clearly already read the background papers, as I was able to make comment on them in discussion. Perhaps it is because of our different backgrounds, but I have come to the conclusion that I use a standard for critically reviewing papers that you are not at, which is understandable, as it is my area of expertise. After all, I would not expect to be able to teach graduate level physics, despite my mastery of the subject as a student, because that is not what I have been trained to do.

As to your question about why I am not, "not calling him (Dr Mike) out on any of his behavior ", I ask you, why would I? He has not engaged me in conversation in anyway. My initial posts were neutral, and my later posts which were directed at specific individuals were in response to their attempts to disagree with my statement that, "lack of evidence of benefit is not has been a ridiculous exercise. I may disagree with the fashion in which he is posting, but an online forum such as this one is no place to successfully teach manners. If it were, someone might have been able to teach you some by now. Note, however, that I have not previously called you out for your continual rudeness, but rather only for your attempts to "BS" us, and only then because it was somehow intended to "discredit" me.

I propose that we return to the discussion I actually posted initially, before all of the name-calling and tantrums.

I put it to the group that although there is SOME data which has been collected on various chiropractic interventions and for the use of these interventions on various diseases / conditions, and that in some cases there is very compelling research (i.e. for use of chiropractics in low back pain), there is not as much research as we would like to see, or could be deemed unequivocally conclusive in an ascetic, academic environment.

This lack of evidence is not a condemnation of the practice of the chiropractor, nor is it an indication that it is either effective or ineffective. We do not have a large enough body of evidence to make either claim "literature based". There are many studies which argue that chiropractic is effective for X, Y, or Z. We also have several studies which indicate that the majority of the positive effects can be attributed to placebo. (which is a common finding in other procedure-based intervention literature, too, for those who are unaware). We have some retrospective analyses and meta analyses papers which indicate that some interventions have potential significant adverse effects, although the occurrence of these is admittedly rare (which is also a common finding in other intervention literature, too, of course). °°°This is not "making an excuse" for anyone, but it is holding a consistent standard and applying requirements equally to all practices while investigating without predisposition or bias.°°°

Thus, in conclusion, I would offer the following:

There is a body of research on chiropractic interventions and those interventions as related to various conditions / diseases.

We need more, however, before any major conclusions can be drawn and classified as "literature based", whether these conclusions be "pro" or "anti" chiropractic care.

As a large section of scientific health care research is publically funded, it would be appropriate for a representative percentage of this funding to be allocated for research into the safety and efficacy of chiropractic health care. I propose that each national government determine what percentage of health care is delivered to their population via chiropractors, and that an equivalent percentage of the federal health care research funding be provided for this purpose; i.e. if 10% of all primary-contact health care is delivered by chiropractors, then 10% of the public research funding should be dedicated to investigating this practice. (10% was a number chosen at random, as I have no idea what the number would actually be) This, of course, means that the research into chiropractics would need to demonstrate all of the accountability and other requirements in place for all publically funded research.

Comments? Agreements? Disagreements? I look forward to lively, and courteous, debate.

Cochrane buddy, you are trying to be rational in the irrational world of the twilight zone skeptics...their badge of office is the quick draw insult and the absolute denial of logic....you will never have a rational discussion with these friends from Hades....I am generally congenial..however my credentials,views and opinions have been disparaged by the mad dogs of skepticisism.......with a vigour that begger belief.....Actually I do find that rather amusing.....as I carve purposefully into the
underbelly of the beast.

Oh'well back to the day job I suppose I have a waiting room full of anxious penitants seeking solace at the alter of pain relief........TTFN

CR:

Oh, puh-lease.

I initially responded to you because you chose to use a subject as an example where you had evidently done very little reading, stated several things which were false, and inadvertantly or otherwise, echoed an anti-vaxxer meme (i.e. HPV vaccines not having been efficacy tested in under-18s). When you were informed of information to the contrary, you did not back down or say anything along the lines of "ok, I was mistaken, there", much less did you acknowledge any inappropriateness of comparison (i.e. something with non-anecdotal evidence vs. something with anecdotal evidence only). In fact, you simply dropped it and shifted the argument to the exchange with "dr Mike", claiming that the evidence for chiropractic intervention in infants is much stronger than it is and that criticisms of these therapies were invalid because unqualified people were performing chiropractic interventions and/or made the criticisms (also false). When I called you on that, once again, you have attempted to shift the ground without acknowledging the criticisms overtly, although I do see some hint of implicit acceptance. I also see in your last post above something of a desperate attempt to defend chiropractic interventions in the face of a complete lack of controlled evidence beyond placebo, frankly; but it would be a lot more respectable if you were capable of acknowledging where your arguments were wrong so far.

As for your "standard for critically reviewing papers that you are not at", god forbid I should ever be down at that level; I sincerely hope to be better than that. Reading back over your comments, either you are inflating your position more than somewhat, or I weep for any journal using you as a reviewer.

But for unwarrented condescension: there I must bow to the master.
[ ::bows:: in your direction]

----
Too rude? No, seriously...I'm not rude to people who don't deserve it. But I have encountered so much sheer stupidity in fields where it has real effects on people's lives, and on occasion had to deal with the fallout of that stupidity when it comes to people going for inappropriate therapies, that I am also seriously disinclined to be polite where people don't deserve it.

FWIW, I see legitimate applications of chiropractic intervention in certain musculoskeletal problems and potentially in the treatment of things like cervically-originating tension headaches. But as the field itself was based in mystical and pseudoscientific nonsense at its inception, has many practitioners still in that realm, and is frequently pushed forward into areas where it has absolutely no legitimate application whatsoever (e.g. treating asthma or diabetes) -- and given that many of its practitioners are as resistant to the principles of science and evidence as the practitioners of New Age "chakra balancing" -- it loses my sympathy quickly. In applications such as treating infants for colic, where the subject is incapable of informed consent and the potential for harm is great, I would insist that there be damn good evidence before I sit back quietly and accept it. And there isn't that good evidence, which is a fact you simply can't get around.

As has been pointed out before, NCCAM has had a huge budget for testing, and has come up with a whole fat lot of nothing, as have the funded studies in Norway and other European countries where chiropractic interventions are popular and well-accepted. So no...I'm afraid it's still hopeful bullshit.

There is a reason for mainstream skepticism. Deal with it.

Now Luna...........gotta bee in your lambswool bonnet.
Go gently on we lesser mortals.......spare us your wrath.
In other words behave yourself young lady.

Now Luna...down to business lets use infant colic.....already I feel you imploding. Show me one bit of evidence where a infant has in any way been harmed by chiropractic treatment of colic. No,Luna you may not quote MD'S AND PHYSIOS WHO HAVE HARMED INFANTS.......its chiropractic . I have myself treated this many times in 3 week old babies with great success...using a very tiny neural stimulation instrument.

Ok...you dont like that I hear you scream.....asthma..who has been harmed by chiropractors treating this condition...Hmmm Hmmmm.
In its simplest sense...to restore function to a dysfunctional rib cage will assist asthmatics immensely...in chiropractic there are many other more sophisticated clinical methods of treating asthma..probably the simplest of which is to order allergy chemistry....and many other methods besides. Now a footnote...medics and chiropractic doctors DO NOT CURE ASTHMA..nobody does...however we do manage the condition successfully for a most grateful patient population by redcuing frequency and severity of attacks and diminishing reliance on medical poisons..eg Steroids/ aminophylline etc etc.....

Now Luna...how difficult can this be and sorry to be techy here.

Your vexed new friend and clinical mentor Dr Mikey.

Luna,

Are you insane? How can my statement that it is reasonable to extrapolate that the HPV vaccine will be effective in young girls even though long term effectiveness data is not yet available be in any way misconstrued as "echoing" an anti-vaccination stance?

I have never argued that the literature support for chiropractic research is stronger than it is. I have repeatedly stated that the research base is too limited to make a literature-based claim, and that more work is needed before anyone could make the claim that the research validates either side of the argument. I do think that taking an unlicensed professional and using them to deliver a treatment does render the study useless, and in that vein, I defy you to find one chiropractor licensed to practice in Germany who was involved in any one of the studies you put forward. I am serious. Find us even one.

As far as NCCAM having a huge budget for chiroractic, as has been posted in this thread already, they spend maybe 10 million a year. In terms of what research costs to perform, this is nothing. If you had any familiarity at all with project design and research budgeting, you would know this. Since you present yourself as someone who does know research, the only explanation I am left with is that you are making this statement deliberately.

I had been previously under the impression that critical review of scientific literature was perhaps not your forte, but now I am under the impression that basic reading comprehension is an issue with you. I am not saying this to be condescending, this is actually a serious question. Maybe there is a third option and you are just not reading all of the posts?

I understand that you will absolutely need to have the last word, and I think that I can let you have it, if you can refrain from being completely ridiculous. Or maybe even if you continue to be so ridiculous that no dignified response would be necessary.

I would, however, be interested in an actual response, from you or from anyone else, about my proposal of allocating a proportionately appropriate amount of public funding for health care research to each area of health care. Private, industry funding, of course, would remain the perogative of the respective industry.

I suspect Luna is out of her/his depth here...all is well when following the party line..however in reality Luna, the party line is skewed with ill informed conjured opinion which naysayers such as yourself Luna share and allocate guilded and embellished to accompany an illogical viewpoint...which seems to be derived from some strange un-researched pre-conceived nominal notion.

I am not sure why I bother to have the debate as a layperson what you offer is detail imbedded in a weak theoretical foundation..............

However, have a nice one.

Cochrane

I think the best summary of how I view the question of "more research into CAM because EBM assessment says there is not enough evidence to decide yet" would be the argument advanced by Kimball Attwood and company over at Science-based Medicine. The problem with the EBM assessment of CAM is that it is, in Attwood's words:

"[being] asked to judge contests pitting low powered, bias-prone clinical investigations and reviews against facts of nature elucidated by voluminous and rigorous experimentation."

And as he continues:

"Thus, although EBM correctly recognizes that basic science is an insufficient basis for determining the safety and effectiveness of a new medical treatment, it overlooks its necessary place in that exercise".

Another way of putting this is that systematic reviews of clinical trials summarise what we know from clinical trials, but do not summarise everything that we know about the intervention/remedy or its practitioners, or what they do to and tell the patients, and so on.

The obvious Alt.Med example of this is homeopathy. After years and years of clinical trials of homeopathy, what we have is a classic demonstration of feeding a "pure placebo remedy" into the trial arena, with all the inherent biases of various kinds that apply there. What comes back is 100% consistent (I would say, as would many others more eminent than me) with pure placebo. Yet the advocates can always find some positive trials somewhere - usually the worse ones - and refuse to accept the negative verdict overall, and so the argument rambles on and on.

So while a neutral startpoint like:

°°°This is not "making an excuse" for anyone, but it is holding a consistent standard and applying requirements equally to all practices while investigating without predisposition or bias.°°°

- is laudable as a philosophical position, it has major problems in practice. What it inadvertently ends up doing, I would argue, is allowing numerous utterly implausible practices to bypass the stage of showing that they are not, frankly, nuts. We could call this "triage", if you will.

Even with the less wacky bits of CAM, the "no preconceptions" approach means one ends up treating things of radically different plausibility as equivalent. An example might be that manipulative therapy for back pain deserves proper testing - I note Luna said something similar - as it has some underlying plausibility and a large existing body of research (though the experts I have read don't regard the evidence base for the intervention as strong, contrary to what you said). However, spinal manipulation for childhood asthma or colic is vastly less plausible, or supported by evidence, and from my perspective frankly doesn't deserve any more public cash to test it out. I can see you disagree with this view, so we will have to agree to differ.

We already have this kind of "triage" in mainstream science and medicine, of course, by dint of the way the funding system operates, but I don't think it applies in Alt.Med. Otherwise why would we see NCCAM funding studies of Reiki and other "biofield therapies", or of intercessory prayer, or of homeopathy?

----------------------------------------------------

On the specific issue of chiropractic - as noted above I would be interested in more, and better, research on chiropractic specifically, and on manipulation generally, for back pain. I would also be interested in more definitive figures on the frequency of different adverse events. If I were funding the research, that is where I would target the money. But for many of the other indications, I am flatly against public funding chasing bad ideas, like chiropractic for asthma, unless someone produces a really compelling piece of evidence to change my mind.

Again on chiropractic, I'm not going to attempt to answer your question about public funding since it is not relevant to the country I live and work in, where CAM interventions are not a major part of our single provider primary care system - a situation I am obviously quite happy with. I think your question was really related to chiropractic in the US setting, so maybe a US-based skeptic would like to respond. In fact, your best bet is to pose the question over at Science Based Medicine, where you will find many experts who I predict will be delighted to debate you on this. I do wonder, though, how many studies of the more plausible CAM interventions NCCAM could fund if it stopped putting large chunks of its money into utter garbage.

Finally, I don't get where you think I have been rude to you. Looking back over my comments to you I would say I have been blunt, and occasionally you seem to have taken offence when you felt I was condescending to you by, as you see it, "declaiming". But blogs comments are not just directed at the "respondent", see my last comment. Re. my tone, like many academic bloggers I see blogs as a place where one can leave the high academic seriousness and PC rhetoric behind and both "let out the funny bone" and air OPINIONS. If that gets up your nose, then - like I said - I think you are in the wrong arena.

Now, I freely admit I HAVE been mildly sarcastic or worse to Dr Mike, whose ad homs and bullshit - in my opinion - richly deserved it. A famous British scientist once remarked that

"Laughter is the best detergent of nonsense"

- which I take to be something of a watchword on the blogs, for good or ill.

PS My latest reading about chiropractic is this post

Aust comments....According to a new systematic review, serious complications of spinal manipulation are rare, but 33-60% of patients experience milder short-term adverse effects.

Now Aust, do you think spinal medicine is a game......of course there can be mild side affects similar to any other clinical procedure and yet I seem to manage to get through the day without patients having side all over the clinic......have you never seen a reaction to a medical procedure....say mild/severe anaphylaxis...or a surgey go wrong......Whats your point.
Are you trying to suggest that a clinical treatment system is not viable due to mild adverse reactions or that a major clinical treatment system such as spinal correction like dental correction should present reaction free to be plausible.....That would be hilarious as the concept would beggar belief.
Yes you have been intentionally unkind to me....but I guess that is part of the arrogance of the self appointed skeptic commentator.

I am begining to wonder what this is all about.....it started with a stupid comment and now its "all chiropractic bad bad bad" ????? hmmm hmm hmmmm I feel I am in the twilight zone minus the weird music.

Actually, all I meant by that particular line in the last comment was that more accurate numbers are needed so that the patients can be given more accurate risk/benefit information - surely a key element of getting informed consent?

To elaborate a little, in the post I linked to in my "PS" Harriet Hall summarises:

"...a significant number of patients report mild adverse effects [from chiropractic manipulation] and... there are rare serious complications from neck manipulation"

- you've just given us an estimate for the first bit; but there isn't a good numerical estimate for the second, and so we need one. I hope you agree.

The description "major clinical treatment system" is what chiropractors say about their version of "spinal medicine". Mainstream medicine views it rather differently. A nice simple summary of the mainstream view of chiropractic can be found in Edzard Ernst's pamphlet (PDF) here.

Actually, Luna has simply had a very busy day. (Given the source, the accusation of illogic and/or incompetence is certainly worth a laugh, though. Kruger-Dunning effect, anyone? ...Also? Not a "lay person.")

But, "dr mike", you want paper references, you will get them...tomorrow. After Sleep. And probably after my morning's work as well, because oddly enough, my job (which pays my mortgage, too, bonus!) takes priority over you, especially given that I have absolutely no reason to believe that you will ever change your mind in the face of evidence.

A couple of quick links for you, now, though:

"A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma"
http://tinyurl.com/lcc4j6

Conclusions In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.

"Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review"
http://www.pediatrics.org/cgi/content/full/119/1/e275

...See, the "what's the harm?" argument goes, even if people are only feeling better because of the placebo effect, then at least they're feeling better, right? My problem with that is, the very worst that a placebo should do is not work. We take risks with mainstream medicine, but only on the basis that we have evidence that the treatment provies something that the body, for whatever reason, cannot do itself. However, to subject people -- especially, in the case of infants or children, those who cannot provide informed consent, to a treatment which at best offers them nothing that their own body can't do and which at worst can cause real and irrevocable harm...that is ethically wrong.

Bah, "provies" == "proviDes"

Thanks a lot for this post. Really nice and simple.

This should finally help you all to fall into line
Chiropractic Research Results for Asthma

Self-reported Nonmusculoskeletal Responses to Chiropractic Intervention:
A Multination Survey
J Manipulative Physiol Ther 2005 (Jun); 28 (5): 294â302
Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%).

Chiropractic Co-management of Medically Treated Asthma
Clinical Chiropractic 2005 (Sep); 8 (3): 140â144
This article presents three cases where patients, being treated by conventional pharmacological means, had chiropractic manipulation administered to the upper thoracic spine twice a week for a period of 6 weeks. Objective measurements were collected using a peak flow meter and subjective data using an asthma specific questionnaire. All three cases resulted in increased subjective and objective parameters and suggest the need for larger studies with appropriate methodology.

Spinal Manipulation May Benefit Asthma Patients
Foundation for Chiropractic Education and Research (FCER)
Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol).

Join Us in Documenting the Effects of Spinal Manipulative Therapy
(SMT) on Asthma
Anthony L. Rosner, Ph.D., Director of Research and Education for FCER
This project, conducted by researchers at Macquarie University in Sydney with 420 subjects, follows on the heels of preliminary observations which suggest that chiropractic management of spinal dysfunction in asthmatic subjects reduces symptoms, anxiety and cortisol levels.

Asthma Trial Update: Preliminary Data Encouraging ~ Your Help Needed to Put Funding âOver the Topâ
Vincent P. Lucido, D.C., President of FCER
This trial is of paramount importance in addressing the major flaws in a previous and unfortunately highly visible clinical trial published in The New England Journal of Medicine. [1] It also represents one of the few investigations that taps into the field of endocrinologyâan area that must be addressed if one is to gain further insight into the systemic effects of spinal dysfunctions and their management by chiropractic care. This research represents only a handful of investigations that have addressed the consequences of manipulation involving chemical (as opposed to electrical) messengers within the body.

Response to the âManual Therapy for Asthmaâ Cochrane Review
Anthony Rosner, PhD, FCER Director of Research
Hondras' recently published systematic review of randomized clinical trials 1 addressed to manual therapy represents a sincere effort to summarize those investigations in what is commonly regarded as the gold standard of clinical research. That said, however, one has to remain particularly vigilant against accepting randomized clinical trials at face value, particularly in those instances involving physical interventions, in which the complete blinding of practitioners [and most likely patients as well] in the traditional RCT design is all but impossible.

Effect of Chiropractic Treatment on the Endocrine and Immune System in Asthmatic Patients
Proceedings of the 2002 International Conference on Spinal Manipulation. 2002 (Oct)
The broad aims of this FCER funded study is to determine whether stress is a factor in the pathophysiology of asthma and to determine if chiropractic management of asthmatics can alleviate stress induced asthma. More specifically for this meeting, our study aims to determine whether chiropractic treatment has beneficial effects on the endocrine system through measurement of salivary cortisol and on the immune system via salivary IgA determination.

Chronic Pediatric Asthma and Chiropractic Spinal Manipulation: A Prospective Clinical Series and Randomized Clinical Pilot Study
J Manipulative Physiol Ther 2001; 24 (6) July: 369â377
After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. You may also be interested in this follow-up letter to the authors which notes the continuing problems with the design of placebos in manual spinal trials.

Chiropractic Management of 47 Asthma Cases
Todays Chiropractic 2000 (Nov) ~ FULL TEXT
Over a seven-year period, 47 cases of asthma were managed in an outpatient setting. Every case was followed for a minimum of two years to observe effectiveness of care. The study group comprised 28 males and 19 females, ranging from 7 to 42 years of age. Of the 47 cases, 32 patients ranged in age from 7 to 19 years.

An Example of Flawed Asthma Research

Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma
New England Journal of Medicine 1998 (Oct 8); 339 (15): 1013â1020
This article raises an interesting question. Was the âSimulated Chiropractic Manipulationâ sham treatment a confounder? How else to explain their findings that âSymptoms of asthma and use of -agonists decreased and the quality of life increased in both groups, with no significant differences between the groups.â You may want to review the Problems with Placebos/Shams Page for a more in-depth discussion of this topic.

Anthony Rosner, Ph.D.'s response to the NEJM Asthma Study
At a time when public interest in the application of alternative medicine is rising, it is regrettable that a study with such deep flaws should have found its way to the lead position in such a prominent journal. Major deficiencies of the study are summarized as follows. Thanks to FCER for permission to reproduce this article. Dr. Rosner is the FCER Director of Research.

Other Responses to This Article by the Chiropractic Academic
and Research Community
Here are comments from researcher Bill Meeker, D.C., Daniel Redwood, D.C., the Meridian Institute, Daniel Becker, D.C., DABCN, James Provoost, D.C., and the Pennsylvania Chiropractic Association.

End of Flawed Asthma Research Articles

Manual Medicine Diversity:
Research Pitfalls and the Emerging Medical Paradigm
J Am Osteopath Assoc 2001; 101 (8) Aug: 441-444 ~ FULL TEXT
Recent studies published in leading medical journals have concluded that chiropractic treatment is not particularly helpful for relieving asthma and migraine symptoms because even though study participants showed notable improvement in symptoms, those subjects who received sham manual medicine treatments also showed improvement. Yet the sham treatment received by control groups in these studies is reminiscent in many ways of traditional osteopathic manipulation. This seems to represent not only a failure to recognize the value of many manual medicine techniques but also an ignorance of the broad spectrum of manual medicine techniques used by various practitioners, from osteopathic physicians to chiropractors to physical therapists.

An Impairment Rating Analysis Of Asthmatic Children
Under Chiropractic Care
Journal of Vertebral Subluxation Research 1997; 1 (4) Jul: 1â8
A self-reported asthma-related impairment study was conducted on 81 children under chiropractic care. The intent of this study was to quantify self-reported changes in impairment experienced by the pediatric asthmatic subjects, before and after a two month period under chiropractic care. Significantly lower impairment rating scores (improvement) were reported for 90.1% of subjects 60 days after chiropractic care when compared to the pre-chiropractic scores (p < 0.05) with an effect size of 0.96.

Osteopathic Manipulative Treatment Applications
for the Emergency Department Patient
J Am Osteopath Assoc 1996; 96 (7) Jul: 403â409
The emergency department (ED) setting offers osteopathic physicians multiple opportunities to provide osteopathic manipulative treatment (OMT) as either the primary therapy or as an adjunct to the intervention. In doing so, osteopathic physicians can decrease or eliminate the morbidity and symptoms associated with protracted dysfunction. Low back pain, chest pain, torticollis, asthma, and sinusitis are some of the illnesses in which OMT should be implemented as part of the management plan

Management of Pediatric Asthma & Enuresis
with Probable Traumatic Etiology
ICA Internat Rev Chiro 1995 (Jan): 37â40
On May 20, 1988 the child was seen for chiropractic examination and evaluation, and from that date to August 3, 1991 the child received 28 chiropractic adjustive/manipulative treatments. Dramatic improvement of asthma and enuresis followed chiropractic management.

A Wholistic Approach to the Treatment of Bronchial Asthma
in a Chiropractic Practice
Chiro J Aust 1993; 23 (1): 4â8
Three case studies involving two children and a mature adult with established diagnoses of bronchial asthma are presented. Management in each case involve chiropractic adjustments combined with a "clinical ecology" approach which has been found useful in identifying food and environmental allergens that may act as triggering factors for asthma attacks. This paper suggests that such a broad-based management approach may lead to higher rates of response to chiropractic treatment of asthma, as well as providing greater long-term relief for its victims.

Manipulative Therapy an Alternative Treatment for Asthma:
A Literature Review
Chiro: The J Chiro Res and Clin Invest 1992; 8(2): 40â42
This is a literature review of the effects of manipulative therapy as alternative treatment for asthma. Subjective studies show that manipulation of the spine relieves the patients' symptoms. However, objective findings have yet to be compiled using respiratory indices. We recommend an extensive study be performed to determine the effects of manipulation on bronchial asthma.

Review More Abstracts on Chiropractic and Asthma
Review abstracts about chiropractic and a variety of organic and visceral disorders at the wonderful International Chiropractic Pediatric Association (ICPA) website

Other Management Approaches for Asthma

The Etiologies, Pathophysiology, and Alternative/Complementary
Treatment of Asthma
Alternative Medicine Review 2001; 6 (1): 20â47 ~ FULL TEXT
Antioxidant nutrients, especially vitamins C and E, selenium, and zinc appear to be necessary in asthma treatment. Vitamins B6 and B12 also may be helpful. Omega-3 fatty acids from fish, the flavonoid quercetin, and botanicals Tylophora asthmatica, Boswellia serrata and Petasites hybridus address the inflammatory component. Physical modalities, including yoga, massage, biofeedback, acupuncture, and chiropractic can also be of help.

Research Perspectives in Asthma: A Rationale for the Therapeutic Application of Magnesium, Pyridoxine, Coleus forskholii and Ginkgo biloba in the Treatment of Adult and Pediatric Asthma
The Internist 1998; 5 (3) Sept: 14â16 ~ FULL TEXT
Thanks to the American Chiropratic Association's Council On Family Practice for their permission to reprint this article exclusively at Chiro.Org!

Natural Asthma Relief
Asthma is best described as a chronic inflammatory condition rather than a respiratory disease. In fact, asthma's origins have more in common with arthritis than they do with emphysema or tuberculosis. Asthma is simply a chronic inflammation of the airway rather than the joints. People with asthma have inflamed, hyperreactive airways that produce excessive bronchial mucus. After repeated asthma attacks, the airway lining becomes scarred, and immune cells, which cause or exacerbate inflammation, proliferate there.2 Asthma eventually damages the airway permanently, making it more prone to inflammation and less functional overall.

Now that we have put the viscer-somatic issue to bed lets turn our attention to chiropractic clinical safety and compare and contrast with our medical colleagues...

Controversy. The Media and professional skeptics feeds on.

Millions of patients love their chiropractor and appreciate our unique and safe approach to recovery from pain. Significant research suggests that chiropractic is the safest approach available for relief from neck pain, back pain, headaches and other âmusculoâskeletalâ complaints. Lets review that research, and discuss how modern medicine has contributed to the Myth that chiropractic care is dangerous.

First, a short review of history

In the early 1960's, the American Medical Association (AMA) decided to try to contain and eliminate Chiropractic as a profession. [ 1 ] The AMA's purpose was to prevent medical physicians from referring patients to Chiropractors, as well as preventing them from accepting referrals from Chiropractors; to prevent Chiropractors from obtaining access to hospital diagnostic and radiology services; to prevent medical physicians from teaching at chiropractic colleges, or engaging in any joint research; and, to stifle any other form of cooperation between the two professions. The AMA also told its membership, medical students, insurance companies, and the general public that Chiropractic was an âunscientific cultâ.

In 1976, five Chiropractors filed a lawsuit against the AMA (and other named entities) for violation of the Sherman Anti-trust Laws. After 15 years of litigation, the U.S. Court of Appeals stated that the AMA intended to âdestroy a competitor,â and that there was evidence âshowing that the AMA was motivated by economic concernsâ. The court found that the AMA had concealed evidence showing it's guilt, and was caught âdoctoringâ documents. The AMA was also âguilty of systematic, long term wrong doing and has not acknowledged its lawlessnessâ. [ 1 ]

Following the Court enforced reversal of AMA's policy, tiny splinter groups formed, with the intention of labeling chiropractic as a quackish cult. Their methods mimicked the earlier AMA suppression tactics: Create doubt about the quality of chiropractic education, and mislead the public into believing that chiropractic claims ALL disease is caused by subluxations. Although these groups hide behind the noble claim that they wish to protect the public from unscientific practices, their true motives are transparent. Their sole intention is to suggest that only allopathic medicine is well supported by scientific research. However, that is just not true!

In an editorial in the highly esteemed British Medical Journal, titled Where is the Wisdom? The Poverty of Medical Evidence, BMJ's editor Dr. Richard Smith recounts a lecture he attended with renowned health policy consultant Dr. David Eddy. Eddy found, after doing significant research, that only about 13% of medical interventions are supported by, solid scientific evidence and that only 1% of the articles in medical journals are scientifically sound. Why is that? Because most of those articles quote from other articles which make unsupported and unfounded claims.

The Increasing Popularity of Alternative Medicine

After publication of David M. Eisenberg's 1993 New England Journal of Medicine article (Unconventional Medicine in the United States), various factions of modern medicine became increasingly anxious and aggressive in their accusations that alternative approaches to medical healthcare were not supported by research. [ 2 ] This same group was NOT forthcoming in mentioning the small fraction of established medical practices that have ever met these same stringent requirements. They certainly never mention the low level of success which medicine delivers for the same health complaints that chiropractic is so famous for.

The High Risks of the Medical Approach

Dr. Lucian Leape, researcher at the Harvard Medical School of Public Health, also states that only 13% of medical procedures have ever been tested for appropriateness by randomized trials. He noted that adverse events occurred in 3.7 percent of all hospitalizations. Worse yet, 13.6 percent of those adverse events led to death! [ 3 ]. He is quoted as saying, âMedicine is now a high risk industry, like aviation. But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!â [ 4 ]

The most comprehensive review of âadverse eventsâ (also referred to as âIatrogenic Injuryâ) caused by modern medicine is the article Death by Medicine, written by Gary Null, Ph.D.; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD. [ 5 ].

This fully referenced report reveals that:

2.2 million people experience in-hospital, adverse reactions to prescribed drugs per year.

20 million unnecessary antibiotics are prescribed annually for viral infections

7.5 million unnecessary medical and surgical procedures are performed annually, and

8.9 million people are exposed to unnecessary hospitalization every year!

The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year!

That is a mind-boggling 2147 people killed daily!

That's 7 jumbo jet plane crashes, each and every day.

That's a 9-11 incident occurring every other day...FOREVER. God help us all.

Now, Lets Discuss the Safety of Chiropractic

Canada has a government-run national health care system. As occurred with Medicare in this country, there had been such pressure on the Canadian government to include chiropractic as a covered benefit, that the Ontario Ministry of Health hired a renowned heath care economist to make a recommendation. The first âManga Reportâ [ 6 ] was published in 1993.

This comprehensive study reviewed all the published literature on low back pain and made some astounding suggestions. In a nutshell, it concluded that: chiropractic should be the treatment of choice for low back pain â excluding traditional medical care altogether!

The specific Findings of the report were:

There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management

Many medical therapies are of questionable validity or are clearly inadequate

There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients.

Chiropractic is more cost-effective. There would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors.

There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management

The specific Recommendations were:
Chiropractic services should be fully insured under the Ontario Health Insurance Plan

Chiropractic services should be fully integrated into the health care system. Because of the high incidence and cost of LBP, hospitals, managed health care groups, community health centers, comprehensive health organizations, and health service organizations and long-term care facilities should employ chiropractors on a full-time and/or part-time basis

A good case could be made for placing chiropractic as the gatekeepers for all musculoskeletal complaints that presented to hospitals.

More Bad News For Medical Patients

A series of articles reporting on the lack of medical training in musculoskeletal disorders was published between 1998 and 2002 by Kevin B. Freedman, MD [ 7 ], [ 8 ]. It seems that the department chairs of several hospital-based orthopedic residency programs designed a basic examination on musculoskeletal competency and gave it to their residents. 82 per cent of medical school graduates failed the examination. Four years later the test was simplified and, once again, 78% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. When this test was given to final quarter chiropractic students 70% of them passed the exact same exam! [ 9 ]

The differences between these 2 student groups should be noted. The medical students had already graduated from medical school (as MDs) and had currently been deployed in rotation through various hospital departments. They had also been accepted into an orthopedic residency program...as the pinnacle of medical musculoskeletal specialists. The chiropractic students however were still just students. 80% medical failure versus 70% chiropractic success. Quite astonishing!

Review of Specific Safety Studies

A. The Safety of Cervical Adjusting

No one pays closer attention to injury statistics than Malpractice Insurance carriers.

Scott Haldeman, MD, DC reviewed malpractice claims records for a 10-year period between 1988 and 1997. In reviewing the outcomes following the application of 134.5 million cervical manipulations (commonly referred to as the chiropractic adjustment), the records indicated that there were 23 reported cases of stroke or vertebral artery dissection (VAD). [ 10 ] Of this group, 10 of the patients had the complicating factors of high blood pressure, use of oral contraceptives, or a history of smoking, all of which are associated with vascular disease. The actual incidence of stroke or VAD following cervical manipulation was found to be one per 5.85 million cervical adjustments. That means that the average chiropractor could work for 1430 years (or practice 48 full chiropractic careers!) before they might be involved with this type of litigation.

Other reports listing a higher frequency of adverse events have been compromised by the tendency of those authors to inappropriately list the pracitioner as a chiropractor, even when it turned out that the injury was caused by a medical doctor, a physical therapist or a hairdresser! [ 11 ], [ 12 ]

Rather than raising concerns about the safety of chiropractic, these statistics emphasize that spinal manipulation, in the hands of unskilled practitioners, is dangerous, and the practice must be closely regulated. [ 13 ]

The World Health Organization recently released a comprehensive set of guidelines that clearly states that chiropractic is a separate profession, rather than a set of techniques that can be learned in short courses by other health professionals. They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services. In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours in chiropractic technique. WHOâs guidelines indicate that a medical graduate should a require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services. [ 14 ]

B. The Safety of Low Back Adjusting

Lower back injury alleged to have occurred following spinal manipulative therapy has been reported in patients with pre-existing disc herniation or prolapse. While it is suggested that the forces required to cause a disruption of the annular fibers of the healthy intervertebral disc well exceed that of a rotational manipulative thrust, some disc herniation/protrusion may certainly be aggravated by an inappropriately applied manipulative maneuver, as it may be by other simple activities of daily living such as bending, sneezing, or lifting. The most frequently described severe complication is compression of the cauda equina by massive midline nuclear herniation at the level of the 3rd, 4th or 5th intervertebral disc.

Of the 30 cauda equina complications associated with manipulation reported in the French, German and English literature over an 80 year period, only 8 were allegedly related to chiropractic treatment. [ 15 ]

The Risks of Medical Procedures Aimed at Relief of Similar Symptoms

A. Non Steriodal Anti-Inflammatories (NSAIDs)

One group of patients who rely on NSAIDs for pain relief are those suffering from rheumatoid arthritis. In 1998, Dr. Singh of the Stanford University of Medicine reviewed the records of 11,000 arthritis patients at 8 participating institutions. He extrapolated that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications (internal bleeding) and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-reported. [ 16 ]

Another article titled â36 Percent of Acute Liver Failures Are Linked to Acetaminophenâ suggests that other organ systems are also compromised by the use of over-the-counter pain medications. [ 17 ]

Lauretti's review of the literature found that The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. [ 27 ]

B. Spinal Surgery

First, let's review some history. In 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. Their findings from the First Surgical Second Opinion Program found that 17.6% of recommendations for surgery were not confirmed. The House Subcommittee on Oversight and Investigations extrapolated these figures to estimate that, on a nationwide basis, there were 2.4 million unnecessary surgeries performed annually resulting in 11,900 deaths at an annual cost of $3.9 billion. [ 18 ]

With the total number of lower back surgeries having been estimated in 1995 to exceed 250,000 in the U.S. at a hospital cost of $11,000 per patient. [ 19 ] This would mean that the total number of unnecessary back surgeries each year in the U.S. could approach 44,000, costing as much as $484 million. [ 20 ]

So, the biggest risk of spinal surgery is that it may not be necessary.

The next set of risks include:

a 2.1% chance of a serious adverse drug reaction. [ 21 ]

a 5-6% chance of acquiring a nosocomial infection [ 22 ]

a 4-36% chance of having an iatrogenic injury (medical error or adverse drug reactions). [ 23 ]

a 17% chance of a procedure error. [ 24 ]

As few as 3%, and no more than 20% of iatrogenic injuries are ever reported! Yipes! [ 5 ]

That takes all the fun out of being a statistic, doesn't it?

This September 2006 article from the Journal of the American Academy of Orthopedic Surgeons says it all:

âFailed back surgery syndrome is a common problem with enormous costs to patients, insurers, and society. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology.â [ 25 ]

That my friends is right from the horse's mouth.

The most recent controversy is from the New York Times:

âSpinal-fusion surgery is one of the most lucrative areas of medicine. An estimated half-million Americans had the operation this year, generating billions of dollars for hospitals and doctors.

But there have been serious questions about how much the surgery actually helps patients with back pain and whether surgeonsâ generous fees might motivate them to overuse the procedure. Those concerns are now heightened by a growing trend among some surgeons to profit in yet another way â by investing in companies that make screws and other hardware they install.â [ 26 ]

Now, added to concerns about medicine's poor musculoskeletal training and dangerous statistics, we have to wonder if the orthopedist might be motivated to install 6 of those $1000 screws in your spine because they are a stockholder in a lucrative medical device manufacturer.

The sanest and safest approach is to use conservative approaches like chiropractic care first. You can always resort to drugs or surgical approaches as a last-ditch resort, but the statistics suggest that most low-back and neck pain can be successfully managed with lower costs and higher patient satisfaction by chiropractors.

You may want to explore research supporting chiropractic care for a wide variety of conditions in our Research section. There is also a significant body of work demonstrating the vastly superior Cost-Effectiveness of Chiropractic, as well as contrasting Patient Satisfaction With Chiropractic with standard Medical Care for the same conditions.

REFERENCES:

[1] The Chiropractic Antitrust Suit ~ Wilk, et al vs. the AMA, et al
The Chiropractic Resource Archives
http://www.chiro.org/Wilk/

[2] Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use
New England Journal of Medicine 1993 (Jan 28); 328 (4): 246â252
http://www.chiro.org/alt_med_abstracts/
ABSTRACTS/Unconventional_Medicine.shtml

[3] Incidence of Adverse Events and Negligence in Hospitalized Patients
Results of the Harvard Medical Practice Study I
New England Journal of Medicine 1991 (Feb 7); 324 (6): 370â376

[4] The Iatrogenic Injury Page
http://www.chiro.org/LINKS/Iatrogenic_Page.shtml

[5] Death by Medicine
Life Extension Foundation
http://www.chiro.org/LINKS/FULL/Death_By_Medicine.html

[6] A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic
Management of Low-Back Pain
Ministry of Health, Government of Ontario Canada 1993
http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml

[7] The Adequacy of Medical School Education in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 1998 (Oct); 80-A (10): 1421â1427
http://www.chiro.org/ChiroZine/ABSTRACTS/Adequacy.shtml

[8] Educational Deficiencies in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 2002 (Apr); 84âA (4): 604â608
http://www.chiro.org/ChiroZine/ABSTRACTS/Educational_Deficiencies.shtml

[9] A Comparison of Chiropractic Student Knowledge Versus Medical Residents
Proceedings of the World Federation of Chiropractic Congress 2001 Pgs. 255
http://www.chiro.org/ChiroZine/ABSTRACTS/
A_Comparison_of_Chiropractic_Student_Knowledge.shtml

[10] Arterial Dissections Following Cervical Manipulation: The Chiropractic Experience
Canadian Medical Association Journal 2001 ( Oct 2); 165 (7): 905â906
http://www.cmaj.ca/cgi/content/full/165/7/905

[11] Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury
J Manipulative Physiol Ther 1995 (May); 18 (4): 203â210
http://www.chiro.org/LINKS/ABSTRACTS/Misuse_of_literature.shtml

[12] Inappropriate Use of the Title Chiropractor and Term Chiropractic Manipulation in the
Peer-reviewed Biomedical Literature
J Manipulative Physiol Ther 1995 (May); 18 (4): 203-210
http://www.chiro.org/ChiroZine/ABSTRACTS/
Inappropriate_Use_of_the_title.shtml

[13] Are German Orthopedic Surgeons Killing People With Chiropractic?
ChiroZine ~ 3-26-2005 ~ Editorial Commentary
http://www.chiro.org/Professional_Regulation/

[14] Guidelines on Basic Training and Safety in Chiropractic
World Health Orgainization ~ November 2005
http://www.chiro.org/LINKS/FULL/
Basic_Training_and_Safety_in_Chiropractic.pdf

[15] Guidelines for Chiropractic Quality Assurance and Practice Parameters
Preceedings of the Mercy Center Consensus Conference; Page 171
Aspen Publications 1993

[16] Recent Considerations in Nonsteroidal Anti-inflammatory Drug Gastropathy
American Journal of Medicine 1998 (Jul 27); 105 (1B): 31Sâ38S
http://www.chiro.org/LINKS/ABSTRACTS/Recent_Considerations.shtml

[17] 36 Percent of Acute Liver Failures Are Linked to Acetaminophen
U.S. News & World Report July 2, 2001
http://www.chiro.org/LINKS/ABSTRACTS/
Liver_Failures_Are_Linked_to_Acetaminophen.shtml

[18] US Congressional House Subcommittee Oversight Investigation.
Cost and Quality of Health Care: Unnecessary Surgery.
Washington, DC: Government Printing Office, 1976

[19] Herman R. Back Surgery. Washington Post [Health Section], April 18, 1995

[20] Testimony to the Department of Veterans Affairs' Chiropractic Advisory Committee
George B. McClelland, D.C., Foundation for Chiropractic Education and Research March 25, 2003
http://www.chiro.org/LINKS/ABSTRACTS/
Testimony_to_the_Department_of_Veterans_Affairs.shtml

[21] Incidence of Adverse Drug Reactions in Hospitalized Patients:
A Meta-analysis of Prospective Studies.
JAMA 1998 (Apr 15); 279 (15): 1200-1205

[22] Nosocomial Infection Update
Emerg Infect Dis 1998 (Jul); 4 (3): 416-420

[23] Error in Medicine
JAMA 1994 (Dec 21); 272 (23): 1851-1857

[24] Medication errors in hospitalized cardiovascular patients
Arch Intern Med 2003 (Jun 23); 163 (12): 1461-1466

[25] Failed Back Surgery Syndrome: Diagnostic Evaluation
Journal of the American Academy of Orthopaedic Surgeons 2006 (Sep); 14 (9): 534-543
http://tinyurl.com/24nn6m

[26] The Spine as Profit Center
New York Times December 30, 2006
http://tinyurl.com/y9qohn

[27] A Risk Assessment of Cervical Manipulation
vs. NSAIDs for the Treatment of Neck Pain
J Manipulative Physiol Ther 1995 (Oct); 18 (8): 530â536
http://www.chiro.org/LINKS/ABSTRACTS/
Risk_Assessment_of_Cervical_Manipulation.shtml

Dr Aust,

You misunderstand. I accused Luna of rudeness. I am actually not sure how that could have been confused.

I do appreciate your attempts at a legitimate discussion, and although I think we will disagree on some fundamental points, it is still interesting to me.

I do agree with your assessment that systematic reviews of clinical trials summarize only what we know from clinical trials and not the entire body of evidence. Given that other studies may have been rejected by various individuals on this forum, however, I ask what, then, you think the gold standard should be? If we should accept lesser studies about the negative aspects of any given intervention (i.e. practitioner bias) should we not also have to accept the lesser studies which might highlight the positive? (i.e. incredibly high self-reported levels of patient satisfaction).

I really don't know that much about homeopathy, and I am less familiar with the research available on it, but I find it hard to imagine that, despite lacking evidence in nearly every other TM/CAM area, there is a massive volume of quality homeopathy literature that has been accumulated over "years and years". I freely admit that I might just not know, but it seems illogical given that nearly every other practice in the TM/CAM arena is so under-researched.

You argue that allocating funding to unproven practices would be a waste, and that to refuse to find them in the first place is a form of triage. (I summarize). I propose that there are many interventions which, although they might seem implausible in the absence of information, could be validated with such research. After all, a great many people used to accept as fact that the earth was flat and that we were the center of the universe. Research would have been deemed unnecessary, because this was an established fact, and any other hypotheses would have been deemed "implausible". I am clearly making a wild comparison, but that does not mean that it does not illustrate my point. How do we know that something will not work when we know nothing about it or anything about how it could work?

I suggest that funding various TM/CAM therapies would be a self-correcting process. As various therapies were found to be ineffective, data would be publicized, the practice would be eliminated from public use, and money would be saved in the long run as the people would stop wasting their money. Refusing to do the research in the first place on the grounds that it would be a waste of money simply allows the practitioners to continue to stand there and say, "well, you haven't proven that it DOESN'T work". This, of course, is just my opinion.

I understand that you don't believe (or at least have made the statement that the scientists you have read do not believe) that there is strong evidence for the benefits of chiropractic in low back pain. I suggest that you get scientists who are a little more up to date on the research. I would propose, for your interest, the New Zealand Commission of Inquiry on Chiropractic (New Zealand) from 1979, the AHCPR Guidelines (USA) from 1994, the Manga et al report (Canada) from 1993, The Spine Journal Special Issue on Evidence-Informed Management of Chronic Low Back Pain Without Surgery (USA, Canada, Mexico, Columbia, Uruguay, Brazil, etc) from Jan/Feb 2008, and the Spine Neck Pain Task Force Report Supplement (International) from Feb 2008, as just a few interesting reads. I acknowledge that I have not read every single word of every single one of these reports, but they are positive to varying degrees, and are either from reputable and reliable sources or drawn from reputable and reliable sources. I don't expect you to drop everything and read these immediately, but I would like to toss them out there as something to look into should you be interested when you have the time.

I agree that some funding for chiropractic should be targeted at assessments of safety. It is a moot point, however, until funding is allocated in the first place.

I note that the intensity of dogmatism of many of the critics here, their violent responses and seeming inability to connect with chiropractic reasoning, makes me suspect that there is such a thing as luddite psychology. It's not just the believer who is special - there's an awful lot going in naysayers heads as well. Where luddites see their automatic dismissal of chiropractic claims, even when made by serious scientists, as a necessary and fundamentally healthy reaction, I see it as dogmatic, intolerant, and quasi zealot/religious in its intensity, indicating a deep seated emotional attraction to the conventional worldview regardless of the consequences.
Strictly speaking, this isn't skepticism at all, at least in its original sense. Where skepsis, in the original Greek, means rational doubt and probing, the word skeptic has increasingly come to mean defensive and doctrinaire, and a skeptic as someone who identifies with a position and defends it to the bitter end, often striving to downplay, bitterly misrepresent or simply ignore the evidence.
Where to go from here..............probably back to the office as I have wasted enough time on this frippery as it is.

Hahahahahahahaha

Err.. and black is white, and day is night, and up is down, too, I guess, Dr Mike.

You are a true star, sir. For pure chutzpah that last comment deserves an Academy Award. Substitute "alternative" or "chiropractic" for "conventional", and you are spot on. But I actually suspect you know that. And I'm not familiar with "chiropractic reasoning", though I rather suspect "parallel reality" is involved.

And if trying to stick to what is experimentally verifiable, or possible within the physical laws governing the known universe, is conventional... well then I guess that makes me conventional.

Anyway, I wish you joy of your own personal alternative reality. It seems to suit you down to the ground.

Aust........whats with the hysterical laugh.
It was not so long ago that YOU were screaming that the earth is flat.........until a chiropractic doctor sailed to the rim and found that it actually curved...of course you did not accept that premise for some further 200 years.
I hope you absorb my meaning.Now just in case you ask me again...the earth is, repeat is, round.
Yes Aust realy...it is round.

Heeellllp

Dr. Mike:

Please explain what causes colic and how spinal manipulation can alleviate it...

Didn't think so.

Hello, A Real Dr. Mike

We meet again...what a pleasure.
Please read the research previously posted above...all the answers to your question are there......I am sure you do not want me to hold your hand and offer a mini CPD course
on the viscero-somatic complex...I just do not have the time.
So please read the research.......I can offer further stacks of research if you feel that I have not already given you enough...but please, I also have others matters to attend to.

Your new friend and clinical mentor Dr Mike

Hey Real Dr Mike,

Although there are many different hypotheses, no one knows what actually causes colic. I would have thought a real doctor would have known that. Until the cause is understood, it is rather difficult to outline a mechanism of alleviation.

Instead, why don't you explain what causes colic and how OTC drugs, chammomile tea, or cuddling the baby can alleviate it. . . or even why they just seem to outgrow it.

Didn't think so.

"dr Mike" -- quite honestly, your comments on the nature of skepticism would carry more weight if I hadn't already seen several thousand permutations of those exact words...coming from creationists/ID-proponents, HIV-AIDS denialists, anti-vaxxers, and any number of that ilk who are deeply miffed that scientists do not respect their worldview.

Now, let's cut to the chase, shall we?

The controlled/blinded trial of chiropractic for asthma you dismiss on the grounds of, if I understand the criticism correctly, the "sham" chiropractic treatment being so like chiropractic intervention that it worked like it, too. Right. Let's leave that aside for now.

What, out of the rest of the long post of copy-pasta above, would allow us to reliably distinguish the effects of chiropractic intervention from placebo and/or simple relaxing massage?

Anything?

Well?

...Now, please revisit my comments on placebo and harm.

Critical Reading:

I never said OTC drugs, chamomile tea, or cuddling the baby can alleviate colic.

I'm not the one making claims here, "Dr. Mike" is.

Dr. Mike:

The studies you and the BCA cited do not support your claims about the efficacy of chiro for colic. Funnily, neither you nor the BCA cite Olafsdottir E, Forshei S, Fluge G, Markestad T. "Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation." Arch Dis Child. 2001 Feb;84(2):138-41. http://adc.bmj.com/cgi/content/full/84/2/138 which concluded that "Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic."

That omission on the part of the BCA indicates willful blindness and reckless disregard of the truth as to whether chiro can effectively treat colic, as the BCA happily promoted.

By the way -- when better evidence comes along that confirms a medical treatment doesn't work -- medicine abandons it. What treatment has chiropractic ever abandoned?

A Real Dr. Mike |There you go again buddy

Quote.......
"By the way -- when better evidence comes along that confirms a medical treatment doesn't work -- medicine abandons it. What treatment has chiropractic ever abandoned?

Ok Real Mike...lets have a look at that one..thank you for bringing it to my attention......It has been known for some 15-20 years that back surgery...does not work...in fact so much is known about this that a new disease has been invented by the medics..its called FAILED BACK SURGERY SYNDROME....The evidence has been around a long time and has never been abandoned by the medics...Ok Real Mike..I hear you say errr uhmmm this is an exception to the rule..realy Real Mike....want some more...there is plenty to go around.

Real Dr Mike...once again thank you for your tongue in cheek highly inventive approach to clinical reality.

Your friend and new mentor ERRR Uhmmm Dr Mike(the genuine one)

Dr. Mike:

Again you prove my point: scientific medicine evolves. Pseudoscience doesn't.

You didn't answer my question.

Again: What treatment has chiropractic ever abandoned?

I retire gracefully to my weekend retreat comforted by the feeling that you skeptics have received a jolly good trumping under my short tenure in this sideshow.

Thanks to all for keeping me amused.

Your departing friend and mentor Dr Mike.
Have a good one.

...you have GOT to be kidding?

"A jolly good trumping"?

I must have missed it. What universe did that occur in?

Yeah, anyway, looks more like running away from uncomfortable questions that you don't even know how to begin to answer, and yelling "ha ha I win!" as you run.

I can see why one might call for "more research", comenserate with the proportion of people who use chiropractic. As A Real Dr Mike mentions, however, the chiropractic profession as a whole has little history of changing practice in the face of research - If we were to spend billions in fully researching the efficacy of some form of chiropractic treatment; how much would it change practice? Definative proof of usefulness would mean they do the same as they always have and proof of ineffectiveness would mean...

They do the same as they always have.

Money wasted.

Luna...you are correct, a jolly good trumping is a tad understated.............whipping boys comes to mind but I am too modest to rub it in but using such an uncharitable phrase.....

Thank you for pointing this out to me.
Your new admirer and clincal mentor Dr Mike.

Dr. Mike:

I see you're happy to claim victory in this little discussion and declare yourself to be my "mentor" and Luna's "clinical mentor".

Yet, despite my two requests, you haven't done what a mentor would: give me information, namely advise me of what treatment or treatments chiropractic has abandoned when contraindicated by the evidence.

Until you provide some evidence, I declare a Scotch verdict.

We are not seeking to show or prove guilt we are seeking to expose the arrogant ramblings of a layman who got snared with his trousers down in the public domain and who then sneakily shifted the emphasis away from his academic incompetence to some vague freedom of speech issue...nothing to do with the original crime against chiropractic clinical practice and nothing to do with the BCA who have no beef with such an issue. This is the joker in the pack or the big fat red herring relating to this nonsense which seems to have entrapped the woolen coated bleating followers of the quasi journalistic shepherd......

Now Real Dr Mike...start your homework here..

Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuresis. J Manip Phys Ther 1995 Mar-Apr;18(3):184-5
Kukurin G. Chronic pediatric asthma and chiropractic spinal manipulation; a prospective clinical series and clinical pilot study. J Manipulative Phys Ther 2002 Oct;25(8):540-1
Anrig C, Plaugher G (eds) Pediatric Chiropractic 1998 page 595, Williams & Wilkins (sleep disorders)
Anrig C, Plaugher G (eds) In Pediatric Chiropractic 1998 page 181, Williams & Wilkins (feeding problems)
Giesen JM, Center DB, Leach RA An evaluation of chiropractic manipulation as a treatment of hyperactivity in children. J Manipulative Physical Ter 1989 Oct;12(5):353-63
Krouse HJ, Krouse JH Complementary therapeutic practices in patients with chronic sinusitis Clin Excell Nurse Prat 1999 No.;3(6_:346-52
Eisenberg D Chiropractic treatment for chronic otitis medial with effusion
Current research at Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Osher Institute, Harvard Medical School, April 2001
Wiberg JM, Nordsteen J, Nilsson N The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 2000 Jun:23(5):365
Budgell B A neurophysiological rationale for the chiropractic management of visceral disorders.
1998 Seminar Proceedings of the Internal College of Chiropractic, Friday Forum Series, February 6, Sydney, Australia (prolonged crying)

Real Dr Mike......You have not exceeded my expectations
A little more effort would be much appreciated.....GO Buddy
Your new friend mentor Dr Mike

"Real Dr. Mike" -- the fake dr Mike persistently claims to be my "mentor" in a deliberate attempt to wind me up, I suspect. It doesn't really bother me, though; it's not like anyone is going to take it seriously, it's just part of the general comedy act on offer.

---However: "dr Mike", despite all your posturing and bragging, yet again you have not answered the direct question I asked.---

In the list of papers and abstracts that you copied and pasted in http://scienceblogs.com/sciencepunk/2009/06/panicking_chiropractors_ord…,

What would allow us to reliably distinguish the effects of chiropractic intervention from placebo and/or simple relaxing massage?

And, I have yet to see a response to you as to why my expectation that placebo should be harmless is in any way incorrect.

Less hot air, more answers, if you have any.

Luna buddyess.....With all due respect..which you may wish to reciprocate sometime when you get your act together..
I have to share with you that the question you ask is hmmmmm shall we say weak.....Here let me help...look,being the third largest primary health profession in the world to chiropractors what you are saying is like asking the medics to show why antibiotics are no better than smarties....
May I be frank...the question is stupid. Try this...if you have a case of cervical lateral foraminal encroachment with LMN symtoms in front of you....you would hardly expect placebo or massage to be a fitting intervention...clinical management is spinal manipulation...Now go see the research to support this.......It may shock you to know that the medics have been advised by their governing bodies to seek out chiropractors by referral for similar kinds of pathology......So the question you ask...may be ok for you as a laymaness but hardly worthy of contemplation by a professional.......chew that type of question amongst yourselves at skepic central.......

Now luna....be nice to your new friend and clinical mentor
and please up your game when asking skeptical piffery questions.

Dr Mike

Shorter version "dr Mike":
"There is no answer to 'how can we tell this apart from placebo' -- so I will go for the 'baffle with bullshit' strategy, shift the playing field to unrelated phenomena, and pretend that you have asked a stupid question."

...There, I made that a bit more coherent for ya.

Really, "dr Mike", I asked you a simple, direct, and very reasonable question about evaluation of the efficacy of chiropractic treatment of asthma. I kind of hoped you would come up with something better than a "Quick, look over there...!" response which does not, in any way, answer this question.

Of course, the problem is that we both know that, out of the list of anecdotes which you have given us about the chiropractic treatment of asthma, there IS nothing which would reliably distinguish chiropractic from placebo effect or relaxing massage. So there isn't a whole lot else you could come up with, I suppose.

...I'm just curious; are you getting something out of this? Because your responses are not exactly going to convince anyone.

Luna I am becoming bored with this...I suspect your strategy is to actually bore me to death......Anyway seeing as it is you.....digest this...its the last I am offering you.

Kukurin G. Chronic pediatric asthma and chiropractic spinal manipulation; a prospective clinical series and clinical pilot study. J Manipulative Phys Ther 2002 Oct;25(8):540-1
Sixteen Infants with Acid Reflux or Colic Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation: A Retrospective Analysis of Outcome
J Pediatric, Maternal & Family Health - Chiropractic May 2009: 1â7

Comparison of the Short-term Effects of Chiropractic Spinal Manipulation and Occipito-sacral Decompression in the Treatment of Infant Colic: A Single-blinded, Randomised, Comparison Trial
Clinical Chiropractic 2008 (Sep); 11 (3): 122â129

Chiropractic Management of Infantile Colic Clinical Chiropractic 2004 (Dec); 7 (4): 180â186

Vertebral Subluxation Correlated with Somatic,Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care
Journal of Vertebral Subluxation Research 2004 (Oct 1: 1â23

Differential Compliance Instrument in the Treatment of Infantile Colic: A Report of Two Cases J Manipulative Physiol Ther 2002; 25 (1) Jan: 58â62

Chiropractic Management of an Infant Experiencing Breastfeeding Difficulties and Colic: A Case Study
J Clinical Chiropractic Pediatrics 2000; 4 (1): 245-247

The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer
J Manipulative Physiol Ther 1999; 22 ( Oct: 517â522

Chiropractic Care of Infantile Colic: A Case Study J Clinical Chiropractic Pediatrics 1999; 3 (1): 203-206

Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases J Manipulative Physiol Ther 1989; 12 (4) Aug: 281â288
Attention Deficit (ADD ~ ADHD) Page
Attention Deficit/Hyperactivity Disorder (ADD ~ ADHD) is the most commonly reported childhood behavioral disorder, affecting between between 3 and 7% of American children. The most common medical âtreatmentâ for this controversial âdiseaseâ is prescriptions of Methylphenidate (Ritalin), a Class II controlled and addictive substance. The long-term effects of this drug on children is unknown, but the side-effects, including addiction, are becoming better understood. Learn more about how alternative approaches (chiropractic, nutrition) can help, without the reliance upon and social stigma of drugs.

Adjusting the Pediatric Spine
Topics in Clinical Chiropractic 1997; 4 (4): 59â69 ~ FULL TEXT
The subject of chiropractic care of children must by necessity include a discussion of the various techniques chiropractors use to address a subluxation. [1â2] The act of introducing a force into a spinal joint in an effort to restore mobility or alignment is termed an adjustment. This article discusses the technical aspects of adjusting the pediatric spine (ie, occiput to pelvis).

Women's Health Page
The Women's Health page contains a variety of information about natural approached to health.

The Pediatrics Book Shelf
Please browse our Pediatric book shelf. Any books you purchase will help to support our non-commercial website.

Kids Need Chiropractic, Too!
This page is a collection of articles by various authors about the need for, safety, and the benefits of chiropractic care for children. Updated 5-27-2009

The Antibiotic Abuse Page
This new page explores the emergence of antibiotic resistant bacteria because of medical over-reliance on antibiotics as a cure-all (especially in children), and due to the use of antibiotics as a fattening agent in animal feed.

Vaccination Information Page
Vaccination is a controversial topic with chiropractors because of our non-drug and non-surgery approach to health. This section attempts to present both sides of the vaccination issue.

Backpacks and Children
This section discusses the effects of backpack loading on children's spines, and compiles articles from the scientific and popular press.

Chiropractic Subluxation and Neurology Articles
Learn more about the Vertebral Subluxation and it's impact on health.

Chiropractic Research for a Variety of Conditions
This page contains abstracts supporting chiropractic care for a wide variety of conditions.

Chiropractic Care for Children?
Point-of-view (POV) pieces, like the Archives of Pediatrics and Adolescent Medicine article cited below, may be viewed as a sound basis for more research, or as a âcall to armsâ for those who consider chiropractic an unsupported fringe therapy. This page is devoted to discussing the literature supporting the need for, safety, and the benefits of chiropractic care for children.

Chiropractic Child Care
This is the 4th chapter of ICA's Recommended Clinical Protocols and Guidelines for the Practice of Chiropractic in Adobe Acrobat (PDF) format.

Pediatric Articles of Interest

Adverse Effects of Spinal Manipulative Therapy in Children Younger Than 3 Years: A Retrospective Study in a Chiropractic Teaching Clinic
J Manipulative Physiol Ther 2008 (Jul); 31 (6): 419â423
This study shows that for the population studied, chiropractic manipulation produced very few adverse effects and was a safe form of therapy in the treatment of patients in this age group.

Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals
Pediatrics 2008 (Apr); 121 (4): e927â935 ~ FULL TEXT
Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% were identified by using traditional voluntary reporting methods. Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations. [Editorial Commentary: These findings (that only 3.7% of adverse events find their way into hospital error reports) is very alarming, and suggests that previous reports have only documented the tip of the iceberg.]

Pediatric Drug Prescriptions
Dynamic Chiropractic ~ March 11, 2008 ~ FULL TEXT
The majority of drugs given to children have never been tested specifically for them. Physicians are prescribing drugs based on a âbest guessâ as to the dosage, efficacy and even safety. The FDA understands that giving medications to children for which there is only adult data available could be harmful, considering that children have dosing concerns and side-effect risks that differ from adults. The latest legislation has made some headway in the battle against the lack of proper labeling; yet, it still fails to completely overcome the absence of research, particularly in the older medications.

Antibiotic Use In Infants Linked To Asthma
The Science Advisory Board ~ June 13, 2007
New research indicates that children who receive antibiotics before their first birthday are significantly more likely to develop asthma by age 7. The study, published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), reports that children receiving antibiotics in the first year of life were at greater risk for developing asthma by age 7 than those not receiving antibiotics. The risk for asthma doubled in children receiving antibiotics for nonrespiratory infections, as well as in children who received multiple antibiotic courses and who did not live with a dog during the first year.

Neck and Shoulder Pains in Relation to Physical Activity and Sedentary Activities in Adolescence
Spine 2007 (Apr 20); 32 (9): 1038â1044
Almost half of the girls and one third of the boys reported mild neck or occipital pain, or shoulder pain, and 3% of girls and 2% of boys reported severe neck or occipital pain, or shoulder pain during the past 6 months. High-level physical activity associated with an increased prevalence of both severe neck or occipital pain and severe shoulder pain in girls, but not in boys. Prolonged sitting was associated with a high prevalence of neck or occipital pain and shoulder pain in girls, and neck or occipital pain in boys. Of various sedentary activities, television watching and reading books associated with neck or occipital pain in girls, whereas playing or working with a computer associated with neck or occipital pain in boys. In girls, television watching also associated with mild shoulder pain.

Full Breast-feeding May Lower Hospitalizations for Infections During First Year of Life
Medscape Medical News ~ July 14, 2006
âOn the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country,â the authors write. âThe results are consistent with early studies and add to the body of evidence confirming the hypothesis that full breastfeeding lowers the risk for hospitalization as a result of infectious diseases during the first year of life in a developed country.â

Is Comorbidity in Adolescence a Predictor for Adult Low Back Pain?
A Prospective Study of a Young Population
BMC Musculoskelet Disord 2006 (Mar 16); 7: 29 ~ FULL TEXT
Your chiropractic care may be working out âkinksâ in your lower back that have been around a lot longer than you realize. This new study of 10,000 Danish residents shows a link between adolescent and adult low back pain (LBP). Researchers studied twins born between 1972 and 1982 by sending out questionnaires in 1994 and again in 2002. The outcomes showed that a high percentage of those who had LBP in 1994 still suffered from LBP in 2002. They also found that those with persistent LBP were 4.5 times more likely than the average person to have future LBP episodes!

Chronic Daily Headache in Adolescents:
Prevalence, Impact, and Medication Overuse
Neurology 2006 (Jan 24); 66 (2): 193â197
Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype; Although this article does not discuss care options for chronic tension-type headache, conservative chiropractic care is the natural choice.

The Course of Low Back Pain from Adolescence to Adulthood:
Eight-year Follow-up of 9600 Twins
Spine 2006 (Feb 15); 31 (4): 468â472
High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30, >30). Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain.

Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy:
A Retrospective Case Series
J Midwifery Womens Health 2006 (Jan); 51 (1): e7-10
Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.

Self-reported Nonmusculoskeletal Responses to Chiropractic Intervention:
A Multination Survey
J Manipulative Physiol Ther 2005 (Jun); 28 (5): 294â302
Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%).

Manual Therapy in Children: Proposals for an Etiologic Model
J Manipulative Physiol Ther 2005 (Mar); 28 (3): e1âe15 ~ FULL TEXT
Manual therapy in children (MTC) is receiving greater attention. Several monographs and reviews deal with this subject (1-4). Although these publications cover the field from the viewpoint of a classic pediatric approach, discussing which diagnoses of pediatric medicine might be successfully treated by MTC, they do not furnish an independent concept for the functional disorders that we see in these children. This article proposes such a framework through a model: the kinematic imbalances due to suboccipital strain (KISS) concept. This concept groups the symptoms and signs associated with functional disorders of the cervical spine into an entity linked to easily recognizable clinical situations. By using this concept as a term in the communication with other caregivers of infants and children, we may be able to improve the contact between pediatricians and specialists of MTC, thus facilitating the identification of those cases where the use of MTC will be most useful.

ICPA and FCER Responds to Pediatrics Article
Itâs a battle that the chiropractic profession is familiar withâa âscientificâ article appears in a medical journal decrying the risks of chiropractic cervical manipulation, and newspapers and television news programs spread the conclusions without either comparison to risks associated with common medical treatments or rebuttal from within chiropractic. The latest front in this battle is over the chiropractic treatment of the pediatric population. Published in the January 1, 2007 issue of Pediatrics, the Journal of the American Academy of Pediatrics, the article âAdverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review,â has quickly reached the airwaves of the popular media.

Adolescent Idiopathic Scoliosis
Dr. Diane Benizzi DiMarco
Due to the close association of spinal maturity with lateral spinal curve progression, adolescent idiopathic scoliosis represents a sensitive topic for those treating females who have entered menarche or will be soon. A lateral bending of the spine, adolescent idiopathic scoliosis can present with a lateral and rotary deformity. Spinal curvatures can be the result of varied factors including; muscle diseases or spasms, neurological disease, diseases of the CNS or PNS, congenital vertebral deformities, leg length inequalities, tumors, pain, injury and degenerative spinal arthrosis. The most common cause of scoliosis, adolescent idiopathic scoliosis, accounts for approximately 80% of all diagnosed scoliosis cases. (1) Females are affected at a rate of 9:1. Idiopathic scoliosis, juvenile and adolescent affect females ages three to ten years of age and ten years to skeletal maturity, respectively. (2,3)

Drug Research and Children
FDA Consumer Magazine ~ JanuaryâFebruary 2003
Most drugs prescribed for children have not been tested in children. Only 20 percent to 30 percent of drugs approved by the Food and Drug Administration are labeled for pediatric use. So by necessity, doctors have routinely given drugs to children "off label," which means the drug hasn't been studied in children in adequate, well-controlled clinical trials approved by the agency.

Evaluation of Chiropractic Management of Pediatric Patients with Low Back Pain: A Prospective Cohort Study
J Manipulative Physiol Ther 2003 (Jan); 26 (1): 1â8 ~ FULL TEXT
Fifteen chiropractors provided data on 54 consecutive pediatric patients with LBP. The average age of the patients was 13.1 years, 57% were male, 61% were acute, with 47% attributing onset to a traumatic event (most commonly sports-related); 24% reported an episode duration of greater than 3 months. Almost 90% of cases presented with uncomplicated mechanical LBP, most frequently diagnosed as lumbar facet dysfunction or subluxation.

Reported Adverse Drug Events in Infants and Children
Under 2 Years of Age
PEDIATRICS 2002 (Nov); 110 (5): E53âE53
Less than 1% of the nearly 2,000 drugs identified in the study were associated with over half of all serious or fatal side-effects. Deaths linked to side-effects were far more likely in the first few months after birth (41% in the first month). In a full quarter of cases, drugs were administered to the mother, not the infant, and then passed to the child through the womb or through breastfeeding. Included in the list of the drugs most likely to cause dangerous side-effects in children were ibuprofen and acetaminophen (drugs more commonly known by such brand names as Advil and Tylenol).

Back, Neck, and Shoulder Pain in Finnish Adolescents:
National Cross Sectional Surveys
British Medical Journal 2002 (Oct 5); 325 (7367): 743â745 ~ FULL TEXT
To study changes in the prevalence of pain in the back or neck in adolescents between the years 1985 and 2001, the authors compared biennial nationwide postal surveys, between 1985-2001, and annual classroom surveys, from 1996-2001. They found that pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders for future adults. Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 43% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds.

The Importance of Prenatal Exposures on the Development of Allergic Disease
Am J Respir Crit Care Med 2002; 166 (6): 827â832 ~ FULL TEXT
This study of British children suggests that women who have an infection or take antibiotics during pregnancy are more likely to have a child with an allergy-related condition such as asthma, hay fever or eczema. Researchers at the University of Nottingham evaluated the medical records of nearly 25,000 British children and their mothers. The study found that children exposed to antibiotics in the womb had a higher risk of developing asthma, hay fever and eczema than did children whose mothers did not take the medication during pregnancy.

Chiropractic Spinal Manipulation for Cervicogenic Headache
in an 8-Year-Old
J Neuromusculoskeletal System 2002 (Fall); 10 (3): 98â103
A case of cervicogenic headache (CEH) in an 8-year-old boy that improved after chiropractic spinal manipulation is reported. An 8-year-old boy presented with a complaint of daily headache. The duration of symptoms was over 3 years. The patient met the diagnostic criteria for CEH. Awkward head position reproduced head pain, as did palpation of the upper cervical region. Decreased range of motion of the neck was evident, as well as abnormal tenderness and primarily of the right upper cervical region, and ancillary myofascial release. A significant decrease in headache frequency as reported by the patient and parent was seen after the first treatment. After four treatments the headache frequency decreased to approximately one per month.

The Webster Technique:
A Chiropractic Technique with Obstetric Implications
J Manipulative Physiol Ther 2002 (Jul); 26 (6): E1â9 ~ FULL TEXT
Intrauterine constraint is defined as any force external to the developing fetus that obstructs the normal movement of the fetus. Intrauterine constraint has been casually related to a number of structural defects of the peripheral and craniofacial skeleton of the fetus. 1-10 Taylor 11 and others 12,13 have described how the forces of intrauterine constraint adversely affect the spine during the prenatal and perinatal periods. Moreover, intrauterine constraint can prevent the developing fetus from attaining a head-down vertex position and achieving a vaginal birth, thereby necessitating a cesarean section delivery.

Chiropractic Advice for Moms-to-Be
American Chiropractic Association
During pregnancy, a woman's center of gravity almost immediately begins to shift forward to the front of her pelvis, according to Dr. Jerome McAndrews, spokesperson for the American Chiropractic Association (ACA). Although a woman's sacrum - or posterior section of her pelvis - has more depth than a man's to enable her to carry a baby, the displaced weight still increases the stress on her joints. "As the baby grows in size," Dr. McAndrews explains, "the woman's weight is projected even farther forward, and the curvature of her lower back is increased, placing extra stress on her spinal disks in that area. As a result, the spine in the upper back area must compensate - and the normal curvature of her upper spine increases as well."

Pediatric Drug Studies: Protecting Pint-Sized Patients
FDA Consumer Magazine ~ MayâJune 1999
Of the nine-item laundry list of medicines Goldberg's 6-year-old daughter Abby was taking for her severe asthma, not a single one was tested or approved in the United States for children under 12. "I feel as though I am testing drugs on my own child, every day, and it isn't helping anyone," Goldberg said... Because of their immature organs and different metabolic and immune systems, children react unlike adults to many drugs. Treating children with adult drugs, then, can carry the risk of unforeseen adverse reactions.

Spinal Manipulation May Benefit Asthma Patients
Foundation for Chiropractic Education and Research (FCER)
Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol).

The Safety of Chiropractic for Children: A Researcherâs Perspective
A survey study examining the practice characteristics and pediatric care of chiropractors 1 in the Boston area estimated that approximately 420,000 pediatric chiropractic visits were made in the Boston metropolitan area alone for 1998. If extrapolated for the rest of the United States and Canada, the number of chiropractic visits to children in one year would be enormous numbering in several million visits. Given this high utilization rate of pediatric chiropractic services in the United States and Canada, statistics should indicate a great number of morbidity and mortality. On the contrary, there exists little evidence of harm to children from chiropractic.

Dramatic Rise in Childhood Obesity
JAMA 2001 (Dec 12): 286 (22): 2845â2848
The authors of a recent study in the JAMA determined obesity trends in over 8,000 children, ages 4 to 12, between 1986 and 1998. The prevalence of overweight children increased over 120% among Hispanic and African-American children and over 50% among Caucasian children in the 12-year study. Nearly one-quarter of Hispanic/African-American children and roughly one-eighth of Caucasian children were considered overweight in 1998.

Prenatal Nutrition
Often when a woman becomes pregnant, or is trying to get pregnant, she develops a new perspective on her health. For most this means a new or renewed interest in nutrition and healthy food choices. Some women are afraid their diet is insufficient and worry it might affect their baby. Others simply want to do everything in their power to have an easy pregnancy and a normal infant. All are valid concerns. They are also opportunities for you to discuss the reasons to supplement, even for those already eating healthfully.

The National Institute of Health (NIH) Takes a Closer Look at Pollution and Children's Health
The National Institute of Environmental Health Sciences (NIEHS) convened the three-day meeting, which will look at indoor and outdoor pollutants' role in asthma, brain and reproductive system disorders, behavioral problems like autism and attention deficit hyperactivity disorder and cancer. Children are especially vulnerable to pollutants because they breathe in more air and take in more food and liquid, proportional to their size, than adults, said Phil Lee, a senior scholar at the University of California, San Francisco, and former assistant secretary at the Department of Health and Human Services. More information like this may be found in our Environmental Toxins Page

Why Should Children Have Chiropractic Care?
More and more parents are seeking chiropractic care for their children. Many spinal problems seen in adults began as early as birth. Even so called 'natural' birthing methods can stress an infant's spine and developing nerve system. The resulting irritation to the nerve system caused by spinal and cranial misalignment can be the cause of many newborn health complaints. Colic, breathing problems, nursing difficulties, sleep disturbances, allergic reactions and chronic infections can often be traced to nerve system stress.

To Treat or Not to Treat Otitis Media: That's Just One of the Questions
J Am Board Fam Pract 2001 (Nov); 14 (6): 474â476
Recent evidence has thrown into question the use of antibiotics and the length of treatment, if prescribed. The growing worldwide development of multidrug-resistant bacteria, the uncertainty of diagnosis, and that up to one third of cases of AOM are viral in origin 12 have made popular a wait-and-see approach to the initial prescription of antibiotics, especially in many European countries. In several randomized clinical trials, antibiotics provided only a small benefit. 13-15 In a meta-analysis of more than 2000 children with AOM, ear pain resolved spontaneously without antibiotics in two thirds by 24 hours and in 80% by day 7.

Chiropractic and Children: It's All About Function
What can chiropractic do for your child? Why do millions of parents bring their children to Doctors of Chiropractic every year? Is it only for highly dramatic health conditions? Is it only for when my child is hurting? Not at all!! Chiropractic's purpose is to remove interferences to the natural healing power running through the body.When that power is unleashed the healing that results may be profound.

Epilepsy and Seizure Disorders: A Review of Literature Relative to Chiropractic Care of Children
J Manipulative Physiol Ther 2001 (Mar-Apr); 24 (3): 199â205
Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.

Chronic Pediatric Asthma and Chiropractic Spinal Manipulation: A Prospective Clinical Series and Randomized Clinical Pilot Study
J Manipulative Physiol Ther 2001 (July); 24 (6): 369â377
After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. You can review many other articles on chiropractic and Asthma in the Research Section.

Ritalin: This Children's Drug Is More Potent Than Cocaine
The London Observer September 9, 2001
Using brain imaging, scientists have found that, in pill form, Ritalin - taken by thousands of British children and four million in the United States - occupies more of the neural transporters responsible for the âhighâ experienced by addicts than smoked or injected cocaine. The research may alarm parents whose children have been prescribed Ritalin as a solution to Attention Deficit Hyperactive Disorder.

Antibiotics/Antimicrobials Ineffective for Treatment of Children
With Acute Sinusitis
PEDIATRICS 2001; 107 (4) April: 619â625
This randomized trial found that neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis.

The Risk of Carcinogenesis From Radiographs to
Pediatric Orthopaedic Patients
J Pediatr Orthop 2000 (MarâApr); 20 (2): 251â254
The use of serial radiographs during the treatment of idiopathic scoliosis, hip dysplasia, and leg-length discrepancy appears relatively safe. The increased risk of carcinogenesis or hereditary defects in these patients is minimal.

Back Pain in Children Who Present to the Emergency Department
Clin Pediatr 1999 (Jul); 38 (7): 401â406
When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.

The ShortâTerm Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer
J Manipulative Physiol Ther 1999 (Jun 11); 308: 1556â1559
This research project found chiropractic adjusting superior to the medical use of dimethicone for the treatment of Infantile Colic.

Prolonged Low-Back Pain in Young Athletes:
A Prospective Case Series Study of Findings and Prognosis
Eur Spine J 1999; 8 (6): 480â484
We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series.

Why the Back of the Child?
Eur Spine J 1999; 8 (6): 426â428
An international congress about "the back of children and teenagers and the prevention of backache" was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP).

Nonspecific Back Pain in Children:
A Search for Associated Factors in 14-year-old Schoolchildren
Rev Rhum Engl Ed 1999 (Jul); 66 (7â9): 381â388
The findings from this cross-sectional study indicate a need for a longitudinal prospective study designed to identify etiologic and prognostic factors of back pain in adolescents, with the goal of devising preventive strategies likely to reduce the risk of low back pain in adulthood.

Research Perspectives in Asthma: A Rationale for the Therapeutic Application of Magnesium, Pyridoxine, Coleus forskholii and Ginkgo biloba in the Treatment of Adult and Pediatric Asthma
The Internist 1998 (Sep); 5 (3): 14â16
Thanks to the American Chiropratic Association's Council On Family Practice for their permission to reprint this article exclusively at Chiro.Org! You can review many other articles on Chiropractic and Asthma in the Research Section.

Acquired Verbal Aphasia in a 7-Year-Old Female: Case Report
Journal of Clinical Chiropractic Pediatrics 1998 (Apr); 1 (2)
A case report is presented of a seven-year-old female patient with acquired verbal aphasia. Despite appropriate referral to specialists in pediatrics, audiology and speech and language pathology, the patients verbal difficulties failed to respond to conventional therapies. Chiropractic evaluation disclosed disclosed biomechanical abnormalities in the spinal and pelvic region and cranium, which had previously gone unrecognized. The patient's speech difficulties improved following the commencement of chiropractic care. Follow-up evaluations over a period of 18 months demonstrated that speech improvements had been maintained. It is impossible to generalize the results of a single case to the population of patients with aphasia. Hoewver, this case study raises important issues regarding the role of chiropractic care in the multidisciplinary management of patients with acquired aphasia.

Back Pain Risk Continues After Pregnancy
Obstetrics & Gynecology 1998 (Feb); 91 (2): 182â186
Women with severe low back pain during pregnancy are at high risk for back pain for more than 10 years after the pregnancy ââ and the problem is likely to recur in a subsequent pregnancy, according to a new study in the journal Obstetrics & Gynecology. More seriously, (19%) of the women with previous low back pain stated they had refrained from another pregnancy because of their fear of the recurrence of their low back pain.

Therapeutic Misadventures With Acetaminophen:
Hepatoxicity After Multiple Doses in Children
J Pediatr 1998 (Jan); 132 (1): 22â27
Twenty-four of 43 patients (53%) died, with an additional three surviving after orthotopic liver transplantation. Parents should be advised about the potential hepatotoxicity of acetaminophen when given to ill children in doses exceeding weight-based recommendations.

Relation of Infant Diet to Childhood Health:
A Seven Year Follow Up.
British Medical Journal 1998 (Jan 3); 316 (7124): 21â25
The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.

The Role of the Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media
Journal of Clinical Chiropractic Pediatrics 1997 (Oct); 2 (2)
To our knowledge this is the first time that tympanography has been used as an objectifying tool with respect to the efficacy of the chiropractic adjustment in the treatment of children with otitis media. In addition, the role of the occipital adjustment needs to be examined. This study begins the process of examining the role of the vertebral cranial subluxation complex in the pathogenesis of otitis media, and the efficacy of the chiropractic adjustment in its resolution. You can review many other articles on chiropractic and Otitis Media in the Research Section.

Are Antibiotics Indicated as Initial Treatment for Children With Acute Otitis Media? A Meta-Analysis
British Medical Journal 1997 (May 24); 314 (7093): 1526â1529 ~ FULL TEXT
Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.

Cervicogenic Hearing Loss
HNO 1994 (Oct); 42 (10): 604â613
Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance. You can review many other articles on chiropractic and Hearing Loss in the Research Section.

Musculoskeletal Injuries in Child Athletes
British Medical Journal 1994 ( Jun 11); 308: 1556â1559
The growing skeletons of children may be injured more easily than the mature skeletons of adults because the bones are more porous and the long bones are further weakened by the epiphysical plates at their proximal and distal ends.

Endometriosis and the Anterior Coccyx: Observations on 5 Cases
Research Forum 1985 (Summer); 1 (4): 120â122 ~ FULL TEXT
This case review involves five women presenting with medically-diagnosed endometriosis. All five women had been advised that they were surgical candidates. Relief of symptoms is effected by adjusting the anteriorally displaced coccyx. The author suggests a relationship between the displaced coccyx and endometriosis and counsels upon the recognition of same.

âJoint Pain in Childrenâ
A Seven Article Series By Deborah Pate, DC, DACBR
Joint pain is a common complaint in children but seldom a symptom of serious joint disease. How can you determine if a child with knee pain has just a strain/sprain or a more serious joint disease, such as Lyme disease, rheumatic fever, or juvenile rheumatoid arthritis? I'd like to review the more common joint disorders affecting children.

Children and Scoliosis
Scoliosis is defined as âany lateral deviation of the spine from the mid-sagittal plane.â While there are many causes for scoliosis, children and adolescents with scoliosis who present to chiropractors usually fall into three categories.

Treatment of Shoulder and Cervical Dysfunction in an Infant
Jan Carll Sharp, R.N., D.C., D.A.C.R.B.
Birth trauma is a term used to describe a variety of conditions resulting from the malpositioning of the fetus. The events leading to this trauma usually occur after the descent of the infant into the birth canal before delivery, regardless of whether that delivery is vaginal or by caesarean delivery. Malpositions can occur as a result of the infant being in an atypical position for a prolonged period of time. This can also happen with the presentation of multiple births causing fetal malpositioning. Some typical injuries may involve the acromio-calvicular joint, the scapula, the cervical spine, the ilio-femoral joint, and the upper and lower extremities. The acromio-clavicular-humeral joint and the cervical spine usually are the primary sites of these conditions.

Otitis Media and the Sanctity of Medical Guidelines
Within recent times, however, we need only consider otitis media as an example of the extreme volatility of medical guidelines. A complete reversal appears to have taken place within just the past six years! Traditionally, the initial recommended intervention in the United States has been tympanostomy with the option to use antibiotics,4 despite that in the United Kingdom, the Scandinavian countries and the Netherlands, physicians have embarked upon a policy of watchful waiting with no deleterious consequences from their reluctance to use antibiotics.5

Top Child Health Agencies Urge Testing to Protect Early Brain Development From Toxins: One Out of Six Affected
One out of six children are suffering from behavioral disorder according to the Learning Disabilities Association and the National Institute of Environmental Health Sciences (NIEHSâNIU). Both are calling for research testing to recognize, reduce and eliminate the environmental toxins scientifically linked to learning disabilities.

The Risk of Injury for Children Exposed to Whiplash Trauma
Arthur C. Croft, DC, MS, FACO
Less than two percent of the literature about whiplash is devoted to children. When I wrote the first edition of my textbook in 1988,1 I cited an older German study placing the risk for children at approximately one-sixth the risk of adults. By the time the second edition was published in 1995, a Swedish study had since been published putting the risk proportion in children closer to two-thirds that of adults.2

Even Small Amounts of Tylenol May Be Dangerous for
Infants and Small Children
In a paper published in Contemporary Pediatrics, Dr. James E. Heubi states that in infants and small children, studies have indicated that the toxic dose is less than twice the recommended dose. Studies have also shown that it is very easy to mistakenly give children too much acetaminophen and, as a result, endanger their lives and health.

Child Acetaminophen Deaths Reported
At least 24 children in the United States have died and three have required liver transplants after receiving accidental overdoses of acetaminophen -- the most widely used medication for relief of pain and fever in children and infants, according to a report in the Journal of Pediatrics.

Protecting Your Child From Computer-related Repetitive Stress
Whether it's typing a school report or surfing the Internet, your child may be spending lots of hours at the computer. By learning about the causes and prevention of repetitive stress injuries now, you can protect your child from future injury.

One-Third Of Children In Road Traffic Accidents Develop Stress Disorder
LONDON, ENGLAND ââ Dec. 11, 1998 ââ In a study of 119 children involved in road traffic accidents during 1997 Dr. Paul Stallard and colleagues from the Royal United Hospital in Bath reveal that one-third were found to be suffering from post-traumatic stress disorder. Published in this week's issue of the British Medical Journal, the study found that young people displayed symptoms including sleep disturbance and nightmares, separation anxiety, difficulties in concentration, intrusive thoughts, difficulties in talking to parents and friends, mood disturbance, deterioration in academic performance, specific fears and accident related play.

Children and the Caffeine Culture
Here is a two-part article on the increasing caffeine consumption by children and youths in the U.S. that appeared in the San Mateo County Times on October 26 and 28, 1998, and probably in other ANG Newspapers in the San Francisco Bay Area. It was written by Dr. Ron Eisenberg and Dr. Virgil Williams, staff physicians at Highland General Hospital in Oakland, California, who apparently write other medical related columns for the newspaper group.

Research: New Challenges for Chiropractic
Review the article and controversy associated with this New England Journal of Medicine article on chiropractic and asthma. We also have the press releases and responses from the Research and Academic Community.

Children Not Eating Enough Fruit and Vegetables
Of 168 US preschoolers who participated in a week-long nutrition study, none ate the five recommended daily servings of fruits and vegetables, report researchers in the Journal of the American College of Nutrition.

Immunization-Related Problems
Janet Zand, L.Ac., OMD
Excerpted from Smart Medicine for a Healthier Child by Avery Publishing Group

The Post-Antibiotic Age
What exactly was this Germ Theory? Very simply, the Germ Theory stated that there were separate diseases and that each disease was caused by a particular microorganism. It was the job of science, then, to find the right drug or vaccine that would selectively kill off the offending bug without killing the patient. That would be great, but nature is rarely so black and white about things, ever notice that? For one thing, bacteria and viruses tend to be "environment-specific." That's why some people get colds and others don't. That's why some survived the Bubonic Plague.

American Academy of Pediatrics (AAP) Addresses Parents Religious Objections to Medical Care
This is a pretty scary statement. Who gets to decide about the health care choices for your child? Parents sometimes deny their children the benefits of medical care because of religious beliefs. In some jurisdictions, exemptions to child abuse and neglect laws restrict government action to protect children or seek legal redress when the alleged abuse or neglect has occurred in the name of religion. The American Academy of Pediatrics (AAP) believes that all children deserve effective medical treatment that is likely to prevent substantial harm or suffering or death. In addition, the AAP advocates that all legal interventions apply equally whenever children are endangered or harmed, without exemptions based on parental religious beliefs. To these ends, the AAP calls for the repeal of religious exemption laws and supports additional efforts to educate the public about the medical needs of children.

Pediatric Associations

International Chiropractic Pediatric Association (ICPA)
The premier chiropractic pediatric research website! The I.C.P.A. is the professions oldest, largest and most respected chiropractic pediatric association. The I.C.P.A. is a non-profit organization, founded by Larry Webster, D.C. who perceived the need for more information, training and research in the field of chiropractic pediatrics. The I.C.P.A. is an independent, non-political organization, and is not affiliated with any other national organization.

ACA Council on Chiropractic Pediatrics
The American Chiropractic Association's Council on Chiropractic Pediatrics (also known as the ACA Pediatrics Council) was established in 2005. Our goals are to support our members who take care of children in their chiropractic practices, and to promote the acceptance and advancement of pediatric chiropractic care.

ICA Council on Chiropractic Pediatrics
The ICA Council on Chiropractic Pediatrics is one of the post-graduate councils of the International Chiropractors Association. It was established in 1993 to bring together doctors of chiropractic who have a special interest caring for children and pregnant women.

Pediatric LINKS of Interest

TeenScreen: Is This Another Ploy of the Psycho-Pharmaceutical Industrial Complex to Force Our Children to Take More Drugs?
TeenScreen is a very controversial so-called "diagnostic psychiatric service" aka suicide survey; done on children who are then referred to psychiatric treatment. The evidence suggests that the objective of the psychiatrists who designed TeenScreen is to place children so selected on psychotropic drugs. "It's just a way to put more people on prescription drugs," said Marcia Angell, former New England Journal of Medicine Editor, medical ethics lecturer at Harvard Medical School, and author of âThe Truth About Drug Companiesâ.

Breastfeeding Information @ CDC
CDC is committed to increasing breastfeeding rates throughout the United States and to promoting optimal breastfeeding practices. This goal can be achieved by supporting breastfeeding mothers, their families, communities, employers, and health care providers by providing education, training, funding, technical assistance, and research.

Child-Neurology Home Page
This website points to many useful neurology resources.

EPA's Office of Children's Health Protection
Children may be more vulnerable to environmental (toxic) exposures than adults because: Their bodily systems are still developing, They eat more, drink more, and breathe more in proportion to their body size, and their behavior can expose them more to chemicals and organisms. Learn more here!

Kentuckiana Children's Center
The ongoing emphasis at Kentuckiana is on special programs individually designed to help the child with special needs. Our goal is to have each child reach his or her optimum potential.

Oklahaven Children's Chiropractic Center
Our mission is to help sick and disabled children back to health through chiropractic care. We believe that the body was wonderfully made and has the capacity to heal itself. Chiropractic adjustments help restore the life force in the body so the body can begin to restore itself to health and wholeness. Take a look around our site and let us know what you think.

Pediatric Journals

Archives of Pediatrics & Adolescent Medicine

European Journal of Pediatrics

Journal of Clinical Chiropractic Pediatrics (JCCP)
Review abstracts on a wide variety of conditions.

Pediatrics Journal

Your friend yawn Dr Mike

Luna Luna Luna

That covers many of many of the areas you worry about....as a basement skeptic.
Lets have no more complaints from you.......as you have now been offered enough material to keep you busy for years.....
That should also keep the Real Dr Mike squinting over the pages for decades...

How many Mikes have we got here anyway.....I suppose immitation is the best form of flattery...Thank you Real Mike.
Now I have patients to see.......TTFN.

...So I take it the strategy is just to continue to dump LOADS of copypasta bullshit, and still not answer the question.

"dr Mike", one last time:

In your own words, if you please, WHAT out of all of that would allow us to reliably distinguish the efficacy of chiropractic treatment of asthma from that of placebo effect or a simple, relaxing massage.

Pick a study or two. About asthma would be preferable, given that this is the subject we were discussing before you started on the "overwhelm them with bullshit" tactic.

Explain how that study allows us to tell the difference between chiropractic and placebo.

Please. See if you can do this. It's now or never. Last chance. ...Just, for the love of little green apples, try to answer the damn question as it has been asked above.

Let me just make clear, too:

If you do another ginormous copypasta dump like that above, you lose. Half that stuff is just random bumff which isn't even vaguely relevant to the question of "how do we know whether or not chiropractic would work"; NONE of it is in your own words, or carries any indication that you understand the study, the issues, or the relevance. (Why I even think that might be possible, given your track record so far, I don't know; I guess I'm just absurdly optimistic that way.) But all it looks like is that you did a keyword search on Google and then pasted in chunks of anything that sounded like it had any connection at all. In terms of answering questions, making your argument, even pretending to have a good-faith discussion, it's just crap.

Don't give me crap.

Luna buddyess...its anger management courses for you.
I a have given you everything. I cited a very large amount of valid data over numerous threads,which you refuse to read
I am sorely disappointed........Stop asking for more.
You have faithfully avoided at all cost the fundamental issue...which is the profession being bushwacked by a journalist...a journalist for heavens sake.
Now,I am not a spokesman for chiropractic...I am a spokesman representing me against vulturism by the fleshpeckers.
The issue is shady journalism...and not the viability of chiropractic...which is beyond doubt.
I have tolerated insults and slurs with good grace and offered in return the very best......to my sheepish detractors.......................
Again I say I am not a spokesman for chiropractic and to have my doctorate insulted left right and centre by you and others is a mark of your disrespect for people in general...Luna,you have shamed yourself....
Now I also see by the tone of your posts that you are slowly seeing my point of view and I look foreward to you championing the cause of chiropractors worldwide after I have altered your wretchedly incorrect ideology in the near future.
Your ex friend Dr Mike.

These will help the chiro detractors see the light...
General Chiropractic Council. Code of Practice and Standard of Proficiency. 2005 http://www.gccuk.
org/files/link_file/COPSOP_Dec05_WEB(with_glossary)
The glossary defines evidence-based care as âclinical practice that incorporates the best available evidence from research, the preferences of patients and the expertise of practitioners (including the individual chiropractor him/herself)â.
07Jan09.pdf
2.
Klougart N, Nilsson N, Jacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 1989 Aug; 12(4): 281-8
A prospective uncontrolled study of 316 infants suffering from infantile colic and selected according to well defined criteria showed a satisfactory result after spinal manipulation in 94% of the cases.
3.
Mercer C, Nook B. The efficacy of chiropractic spinal adjustments as a treatment protocol in the management of infantile colic. In Haldeman S, Murphy B (eds) 5th Biennial Congress of the World Federation of Chiropractic: Auckland 1999: 170-1
Resolution of symptoms in 93% of infants treated with spinal manipulation. Study supports the suggestion of a beneficial effect of chiropractic.
4.
Wiberg J, Nordsteen J, Nilsson N. The short term effect of spinal manipulation in the treatment of infantile colic. A randomised controlled trial with a blinded observer. J Manipulative Physiol Ther 1999; 22: 517-522.
A randomised controlled trial comparing spinal manipulation with dimethicone. The study concluded that spinal manipulation is effective in relieving infantile colic.
5.
Bronfort G, Evans RL, Kubik P, Filkin P. Chronic paediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomised clinical pilot study. J Manipulative Physiol Ther 2001 Jul-Aug; 24(6): 369-77.
After 3 months of combining chiropractic spinal manipulation with optimal medical management for paediatric asthma, children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. The observed improvements are unlikely as a result of the specific effects of chiropractic spinal manipulation alone, but other aspects of the
clinical encounter that should not be dismissed readily.
6.
Morley J, Rosner AL, Redwoord D. A Case Study of Misrepresentation of the Scientific Literature: Recent Reviews of Chiropractic. J Altern Complementary Med. 2001; Vol 7, No 1; 65-78
The article discusses inter alia the conduct of medical researchers. It deals with misrepresentation, calls for full debate and raises serious questions about the integrity of the peer-review process and the nature of academic misconduct.
7.
Kukurin GW. J Manipulative Physiol Ther 2002 Oct; 540
(Letters to editor) [The results] add to a curious trend reported in the literature, namely that patients report improvement in their asthma after a course of chiropractic manipulative therapy.
8.
Bockenhauer SE, Julliard KN, Lo KS, Huang E, Sheth AM. Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. J Am Osteopathic Assoc 2002 Jul; 102(7): 371-5
Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures.
9.
Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt BF. The use of osteopathic manipulative treatment in children with acute recurrent otitis media. Arch Paediatr Adolesc Med. 2003 Sep; 157(9): 861-6
The results of this study suggest a potential benefit of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media; it may prevent or decrease surgical intervention or antibiotic overuse
10.
Guiney PA, Chou R, Vianna A, Lovenheim J. Effects of osteopathic manipulative treatmenton paediatric patients with asthma: a randomised controlled trial. J Am Osteopathic Assoc 2005 Jan; 105(1): 7-12.
With a confidence level of 95%, results for the manipulation group showed a statistically significant improvement of 7 L per minute to 9 L per minute for peak expiratory flow rates. These results suggest that spinal manipulation has a therapeutic effect among this patient population
11.
Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. Chiropractic care for non-musculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med. 2007 Jun; 13(5) 47980
Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic
vertigo, and infantile colic. Evidence was promising for potential benefit of manual procedures for children with otitis media
12.
Thiel HW, Bolton JE, Docherty S, Portlock JC. Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine 2007 Oct; 32(21): 2375-8
Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low
13.
Cassidy JD, Boyle B, Cote P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebro-basilar stroke and chiropractic care: results of a population based case control and case crossover study. Spine 2008 Feb 15; 33 (4 suppl): S176-83
The increased risks of VBA stroke associated with chiropractic and [GP] visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. It was found that there was no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care
14.
Bronfort G, Haas M, Moher D, Bouter L, van TulderM, Triano J, Assendelft WJ, Evans R, Dagenais S, Review conclusions by Ernst and Canter regarding spinal manipulation refuted. Chiropr Osteopat 2006 Aug; 14:14 .
Based on a critical appraisal of their review, the authors of this commentary seriously challenge the conclusions by Ernst and Canter who, they say, did not adhere to standard systematic review methodology, thus threatening the validity of their conclusions. There was no systematic assessment of the literature pertaining to the hazards of manipulation, including comparison to other therapies. Hence, their claim that the risks of manipulation outweigh the benefits, and thus spinal manipulation cannot be recommended as treatment for any condition, was not supported by the data analyzed. Their conclusions are misleading and not based on evidence that allow discrediting of a large body of professionals using spinal manipulation
15.
Froehle RM. Ear infection: a retrospective study examining
93% of all episodes improved. The studyâs data indicates that
improvement from chiropractic care and analysing for influencing factors. J Manipulative Physiol Ther 1996 Mar; 19(3): 169-77
⦠the addition of chiropractic care may decrease the symptoms of ear infection in young children..
16.
Glazener CM, Evans JH, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005 Apr 23; 2: CD005230
There was weak evidence to support the use of [chiropractic]
17.
Hayden C, Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infant colic. Complementary Ther Clin Prac. 2006 May; 12(2): 83-90
The preliminary study suggested that cranial osteopathic treatment can benefit infants with colic.
18.
Hipperson AJ. Chiropractic management of infantile colic. Clinical Chiropractic 2004 Sep; 11(3): 122-129
The two case studies demonstrate chiropractic treatment successfully restoring correct spinal and cranial motion with an associated resolution of symptoms.
19.
Browning M, Miller J. Comparison of the short term effects of chiropractic spinal manipulation and occipitosacral decompression in the treatment of infant colic: a single blinded randomised controlled trial. Clinical Chiropractic 2008 Sep; 11(3): 122-129.
A single blinded randomised controlled trial. The study showed that both spinal manipulation and occipitosacral decompression offered significant benefits to infants including increased sleep and decreased crying.
20.
Leach RA. Differential compliance instrument in the treatment of infantile colic: a report of two cases. J Manipulative Physiol Ther 2002 Jan; 25(1):58-62
The mechanical adjusting device used was well tolerated and beneficial in two cases of infantile colic.
21.
Reed WR, Beavers S, Reddy SK, Kern GJ. Chiropractic management of primary nocturnal enuresis J Manipulative Physiol Ther 1994 Nov; 17(9):
Wet nights were significantly reduced after spinal manipulation. The study âstrongly suggestsâ the effectiveness of chiropractic treatment for primary nocturnal enuresis.
22.
Blomerth PR. Functional nocturnal enuresis. J Manipulative Physiol Ther 1994; 17: 335-338.
The patientâs enuresis resolved with the use of manipulation. This occurred in a way that could not be attributed to time or placebo.
23.
Fallon JM. The role of the chiropractic adjustment in the
The results indicate that there is a strong correlation between
care and treatment of 332 children with otitis media. J Clin Chiropract Paediatrics 1997 Oct; 2(2): 167-183
the chiropractic adjustment and the resolution of otitis media for the children in this study.
24.
Miller J. Cry babies: a framework for chiropractic care. Clinical Chiropractic 2007 Sep; 10(3) 139-46
A rational framework is proposed for the care and management of excessive infant crying.
25.
Nilsson N. Infant colic and chiropractic. Eur J Chiropr 1985; 33(4): 264-265
Respondents to a questionnaire revealed that 91% of infants improved after 2-3 manipulations.
26.
Sackett DL, Rosenberg WH, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isnât.
Evidence based medicine is about integrating individual clinical expertise and the best external evidence.
27.
Blower AL, Brooks A, Fenn CG, Hill A, Pearce MY, Morant S, Bardhan KD. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther 1997;11: 283-91.
There is a strong association between NSAID use and propensity for upper gastrointestinal emergency admission; NSAID use is associated with significant morbidity and mortality each year in the UK.
28.
Hawkey CJ, Cullen DJ, Greenwood DC , Wilson JV, Logan RF. Prescribing of nonsteroidal anti-inflammatory drugs in general practice: determinants and consequences. Aliment Pharmacol Ther 1997;11: 293-8.
The data are compatible with 1 hospital admission per 2823 NSAID prescriptions and they emphasise the need for strategies to reduce levels of NSAID prescribing.
29.
M MacDonald TM, Morant, Robinson GC, Shield MJ, McGilchrist MM, Murray FE, McDevitt DG. Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study. BMJ 1997 315: 1333-7.
The study provides evidence that NSAID toxicity persists with continuous exposure and that this toxicity persists after the end of prescribing. http://www.ministryoftruth.me.uk/wp-content/uploads/2009/06/BCA-Stateme…

Luna these articles cover fully aspects of the somato-visceral complex..asthma colic etc etc.....I do not propose to perform an autopsy on them...that is your job, do it.
As for quick one liner answers to clinical topics like your favourite asthma...there are no quickies that is purely layman speak. You need to understand what has been researched and draw your own conclusions.

Now I am not going to talk to you any more until you are nice to me.

Dr Mike..ex mentor ex friend ex advisor to Luna.

Ok, honestly, not-really-a-dr.-Mike, I'm not sure whether to give you points for sheer bald-faced cheek, or just decide that you really are that much of an idiot.

Kind of leaning towards idiot.

Everything I said about "pick a study or two, please tell me in your own words how this supports distinguishing chiropractic intervention from placebo in asthma"...did that just go totally over your head? Did I use too many big words and it confused you? Or did you just decide, what the hell, no need to have any sort of real interaction when you can just spew into the blogosphere until everybody stops talking to you?

There were two, count them two relevant studies in that regurgitated copypasta. We could have had some sort of discussion about them. But I'm afraid I'm going to just leave you with your comforting delusions of competence.

And in conclusion

Asthma
A study published in the November / December 2000 issue of Today's Chiropractic gives some insight into the use of chiropractic in combating asthma. Forty seven patients were observed for a two year period. They had been medically diagnosed with persistent asthma ranging from mild persistent in 11 cases, moderate persistent in 28 cases, to severe persistent in 8 cases. The care rendered consisted of specific chiropractic adjustments. The range of visits was from 14 to 44, with the average being 26 during the study period.
All 47 of the study patients showed "a marked improvement ranging from 87 to 100 percent." Their symptoms improved as well as a decrease in their usage of acute asthma attack medication. Even more impressive was the fact that all of the patients in the study reported maintaining their improvement after a two-year follow up.

Childhood Asthma and Chiropractic

Chiropractors suggest that there is a strong link between people who suffer from childhood asthma and nerve interference from subluxation. Subluxations are when bones in the spine pressure or irritate nerves causing abnormal nerve function.

An article published in the Journal of Vertebral Subluxation Research (Vol. 1 No. 4) showed positive effects of chiropractic care on 81 children with asthma. It concluded that "Based upon information currently available, chiropractic care represents a safe non-pharmacological health care approach, that may be associated with a decrease in asthma-related impairment, reduced respiratory effort, and a decrease incidence of asthma attacks. The correction of vertebral subluxation could reduce or eliminate the need for medication, and potentially ease the severity of the asthmatic condition."

This was verified in another study. In a study conducted in 1996 by the Michigan Chiropractic Council (MCC), a panel of doctors performed an out-come assessment study to test the qualitative and quantitative effectiveness of chiropractic care on children with asthma. There was an overwhelming interest in the study. More than 500 parents called the MCC seeking to get their child involved in the chiropractic study.
The study, which took place during May and June of 1996, examined the chiropractic effectiveness in correcting the cause of asthma in patients from birth to age 17. The average age of the participant was 10 years. After 30 days of chiropractic health care, patients averaged only one attack, whereas prior to the study they were experiencing more than four attacks. Medications were decreased by nearly 70 percent. Patient satisfaction was rated 8.5 on a scale of 10. More than 70 chiropractors from 62 cities in Michigan participated in the study involving more than 80 children suffering from asthma.

The International Chiropractic Pediatric Association cites several studies when coming to the following conclusion discussing the benefits of chiropractic for children with asthma:

76.5% of patients with bronchial asthma said they benefited from chiropractic treatment. Peak flow rate and vital capacity increased after the third treatment. Significantly lower quality of life impairment rating scores were reported for 90.1% of children after 60 days of chiropractic care. During this same time period the average number of asthma attacks decreased an average of 44.9%, and asthma medication usage was decreased an average of 66.5%. Among parents of asthmatic children who had received chiropractic treatment, 92% considered this treatment beneficial. Autonomic Nervous System and Chiropractic Adjustments
Researchers found that chiropractic adjustments have an effect on the Autonomic Nervous System. They measured the changes in "Edge Light Pupil Cycle Time" (ELPCT) which is one of the light reflexes of the eyes. This reflex is controlled by the Autonomic Nervous System. A decrease in the Edge Light Pupil Cycle Time was observed with chiropractic adjustment implying a direct link between a chiropractic adjustment and a response in the Autonomic Nervous System. The study was published in the September 2000 issue of the Journal of Manipulative and Physiologic Therapeutics.

If this is true, it will have implications well beyond vision problems. The Autonomic Nervous System is that part of the nervous system responsible for the control and function of internal body organs. Chiropractors believe that interference to the nervous system creates a situation whereby various parts of the body will not be functioning at their full potential. This research shows a link between chiropractic adjustments of the spine and the part of the nervous system responsible for the control of internal organs. Chiropractors suggest that this shows conclusively that chiropractic care can have a positive affect on organ system health problems.

I now rest my case.

Dr Mike

"your case" -- which you simply copied-and-pasted wholesale, unchanged, without attribution, from http://www.holisticonline.com/Chiropractic/chiro_asthma.htm .

Plagiarism is generally a big red flag for dishonesty. Even more than that, however, there is hardly any point in trying to have a discussion with someone about methodology or the merits of studies when they can't even manage the concept of "in your own words".

Try performing research without the drug company sponsorship
Thats your answer in short....For what the profession has actually achieved in the research domain they should be congratulated...so get real.
If the consumer of clinical treatment or the skeptics dont like that....well tough nuts who cares.....other than you..
The simple answer for them is to avoid chiropractics clinics and treatment at all cost.......I am sure the profession can live with that in fact I am certain off that..
As for going out to please the world and satisfy the naysayer....actually we are too busy to be encumbered...

So moan complain gnash teeth and toss ashes in your hair
Come Monday morning chiropractic offices will be open for business as usual and..strange as it may seem to you VERY BUSY.
In other words I could not care less about offering you any further debate regarding the merits of chiropractic research.................

Would like to point out that TV psychics also make very good money.

Not-a-doctor-Mike, your 'answer' boils down to non sequitor, dodge, and an "I don't care as long as I still get money off the public."

...Oh, and by the way? The content you ripped off, above, is actually copyrighted material from International Cyber Business Services, Inc., and in direct contravention of their explicitly stated terms of service, making your plagiarism a criminal act. Might want to watch that.

I see you are getting your knickers in a twist over this Luna......please take a powder and relax find a hobby interrogate alian abductees.......go fishing.

Look Luna nobody likes a damn good trumping like you have had to endure over your failure to "do down" chiropractic.
Just face the fact that you have failed miserably....
Yes Dr Mike will be gracious and not say you have been made to look like a donkey....only a little silly thats all.
Its okay someday you will bounce back with vigour to champion some new lost cause....so have a short break and get some sun.

Thanks
Dr Mike

_ _
o_0

Yeaaahhh....

not-a-dr.-Mike, if you were genuinely as far divorced from reality as you appear, you would be institutionalised, so I can only assume that you are just trolling for fun now. ...Yes, you are an arse as well as an idiot. Good for you.

The plagiarism: your problem, not mine. But nevertheless, a problem.

Dr Mike wrote:

Come Monday morning chiropractic offices will be open for business as usual and..strange as it may seem to you VERY BUSY

Well, perhaps. I suspect that in a recession-hit UK, and post the BCA vs. Singh furore and the attendant coverage of chiropractic's more ludicrous statements and beliefs, this is rather unlikely to be true.

And above my Google mailbox is a sponsored ad that says:

"Chiropractic consultatation including treatment for only £ 16"

- which suggests to me that business is not booming.

Just a short footnote
The Singhy thingy has boosted chiropractic immensely.
We get national coverage....full exposure.
We demolish the Singhy thingy in full view of the public.
People are asking...why they have we not been referred to doctors of chiropractic...
We are in the news and newspapers all the time with very positive exposure.
Our representatives give TV interviews radio shows...
Our techniques and expertise are talked about.
Our research is positively reviewed....
More money reaches our training universities....
Our public profile is enhanced.....
Our clinics are bulging.....

A big thanks to all you nocturnal enuretics for helping further estabish the profession in the UK and internationally and for exposing the cranks and frauds who do not wish us well......

As we say in the US...It dont get no better.

Dr Mike

We'll see how the BCA's libel suit plays out.

However, the plethora of evidence the BCA has cited to support its claims that chiropractic can treat infant colic etc. has already been found wanting by many astute bloggers. Far from demolishing the Singh thinghy, it has only confirmed what Singh claimed and the BCA sued over.

If the BCA was so confident in its assertion that Singh's opinion was wrong, why have they removed the Happy Families brochure from their website?

Why have many chiropractic practices in the UK been engaging in a scorched-earth policy to remove claims of chiropractic's effectiveness in treating many conditions over the last few weeks?

I note that you never did answer my simple question from almost a week ago -- what treatments has chiropractic abandoned once it found they did not work?

Andy D,

I agree. This sitation has nothing to do with the Singh case. . . which is why I didn't mention the Singh case at all. This blog is about the stuff the McTimmoney Chiropractic Association sent out. The only reason I mentioned the BCA is because they are the largest association of chiropractors in the UK, and they do not accept that the McTimmoneys are adequately trained.

My point was that this insane e-mail was sent out by a tiny subsection of the population, and is not representative of chiropractors as a whole.

Thanks for pointing this out.

Chiropractors believe that interference to the nervous system creates a situation whereby various parts of the body will not be functioning at their full potential. This research shows a link between chiropractic adjustments of the spine and the part of the nervous system responsible for the control of internal organs.

No upper cervical specific should be affected. Those are the good ones. not the ones who use cavitation .full spine, and diversified use cavitation popping of the joints. Learn good techniques like atlas orthogonal add light toggle recoil. at Sherman collage.Duff Method. This is a way of measuring changes.when you look on www.upcspine.com look for practitioners. knee Chest is a technique not mentone4d on upcspine,but it is still a good technique,and use it if it is near you. Absolutely positively everyone in the world needs to be evaluated by a U,C,S only care doctor. learn how to recognize one, and learn the technique names on upcspine. MUCC.us/ listen to the audio.

Why is that there are many issues about some of the chiropractor? Was it because of the unsuccessful treatment of their patient?

Everything I said about "pick a study or two, please tell me in your own words how this supports distinguishing chiropractic intervention from placebo in asthma"...did that just go totally over your head? Did I use too many big words and it confused you? Or did you just decide, what the hell, no need to have any sort of real interaction when you can just spew into the blogosphere until everybody stops talking to you?

There were two, count them two relevant studies in that regurgitated copypasta. We could have had some sort of discussion about them. But I'm afraid I'm going to just leave you with your comforting delusions of competence.

There were two, count them two relevant studies in that regurgitated copypasta. We could have had some sort of discussion about them. But I'm afraid I'm going to just leave you with your comforting delusions of competence good.