A new study by Edzard Ernst and Andrew Gilbey recently appeared in the New Zealand Medical Journal surveying Internet advertising claims made by individual chiropractors and major chiropractic organizations from Canada, the U.S., New Zealand, and The U.K.
They divided the claims into those for which there is reasonable evidence of some benefit (lower back pain) and those for which no good evidence of efficacy exists (headaches, migraines, colic, asthma, ear infections, neck pain, and whiplash). What is not surprising is that chiropractors, and the professional organizations that represent the profession generally, routinely suggest or outright state that their manipulations can treat conditions which they cannot. 95% of individual chiropractic websites made at least one such claim, and all of the professional associations did as well. 38% of the chiropractors made treatment claims concerning all of the conditions in the survey which chiropractic has not been shown to actually treat.
What is a bit more surprising is that many of the sites and organizations did not promote chiropractic for lower back pain, the one condition for which the evidence of some benefit is decent. Only 28% of the individual sites and 4 out of 9 association web sites specifically mentioned lower back pain. One would think they would be most aggressively advertising their treatments for the diseases for which the best evidence exists that they actually help. But remember, chiropractic is, for the most part, really a faith-based practice founded on the non-existent subluxation and the vitalist “innate intelligence,” not an evidence-based medical specialty. It is true some individual chiropractors are exceptions to this rule and limit themselves to treating musculoskeletal pain. And there are some signs that the profession may be moving to downplay the subluxation mythology. But in general, the practice of chiropractic is still dominated by 19th century spiritualist notions and isn’t much interested in the verdict of science on its efforts.
So how do we explain the apparent de-emphasizing of the most reasonable claims chiropractic could make? I suspect that there is a deliberate effort on the part of the chiropractic profession to avoid getting limited in the public’s mind to treatment of musculoskeletal pain. Chiropractors want to be seen as an alternative choice to conventional medical providers, and they want to be involved in much more than just the treatment of musculoskeletal pain. So despite the lip service they may pay to the concept of evidence-based medicine, in reality they are convinced their treatments work for all sorts of problems regardless of the lack of evidence, and they want to protect and nurture the false impression the public may have that chiropractic is good for more than just back pain.
We have recently published a peer reviewed article reviewing some European and American courses in animal chiropractic for veterinarians and (human) chiropractors jointly. We looked at the BackBone-Academy and International Academy of Veterinary Chiropractic (IAVC), and their mother organisations Healing Oasis and Options for Animals, respectively.
It is in Swedish in the Swedish Veterinary Journal (Svensk Veterinärtidning), but with an English summary (provided below). Unfortunately, at present we have no plans of getting it published in English.
The first author is a vet, the 2nd an MD.
Ekström Kjellin, Ragnvi, and Olle Kjellin, Är djurkiropraktik lege artis för veterinärer. Svensk Veterinärtidning 2010(6):19-24
Summary
Is animal chiropractic in accordance with best practice for veterinarians?
To get an idea of the contents and scientific level of what is taught at courses in animal chiropractic, the web sites of some training organizations were scrutinized. Also, a course compendium from one of them was analysed. It was found that the scientific quality of the courses is strikingly low, as established facts are mixed with unsubstantiated claims and pseudoscientific ideas. Many methods taught are clearly outside the realm of science and best practice. In conclusion, the value of animal chiropractic to veterinary medicine is strongly questioned.
Thank you very much for pointing out this study. It would be very useful to be able to have an English language version, if that is ever possible.
We have now almost finished an updated version in English of the above-mentioned Swedish article. I wonder if I may ask you (or someone else who reads this) to have a pre-look at it and give us some comments, for contents as well as the language? And suggest which journal to submit it to?
Sorry, for the ddelayed reply. I’ve been traveling.
I’d be happy to look over the article if you like.
Thank you, that´s very kind of you. We are not ready yet but we´ll get back to you in due time.
Sounds like the same old rhetoric to me, pity that none of these “experts” has dual qualifications, in both professions….too much heat and not enough light if you ask me. But people, and now pets, horses, and their owners must be voting with their feet, if these sceptics are so concerned. Perhaps it is time, the “scientists” did some real investigation, and not just rumour mongering. By the way…I like the concept of Innate Intelligence…some internal order, which controls the body, its functions, repair mechanisms..and so. Don’t think it all happens by chance…do you?
Dr. Bridson,
Since chiropractic is, apart from a few solidly science-based exceptions, mostly a faith-based belief system in vitalism and in effects validated only by anecdote and not research evidence, to claim that only people qualified as chiropractors should be taken seriously is like saying only astrologers or psychics should be taken seriously when evaluating those belief systems. It is precisely the point that if something is true, objective, skeptical outsiders should be able to replicate its effects and prove it true just as easily as true believers.
As for people voting with their feet, sceintific reality is not decided on the basis of popular opinion, so this is certainly not an argument in favor of chiropractic. It is, unfortunately, a sad example of how easily people can be misled, intentionally or not.
What would you consider “real investigation” as opposed to “rumour mongering?” Seems to me there is an enormous scientific literature on the subject of chiropractic, and conclusions based on this are hardly “rumours.” This particular study demonstrated in a fairly objective way that what chiropractors claim in their advertisements is not the same as what they can legitimately demonstrate through scientific means to be true. This seems a legitimate ethical problem.
“I like the concept of Innate Intelligence…some internal order, which controls the body, its functions, repair mechanisms..and so. Don’t think it all happens by chance…do you?”
You may like the idea, and it may comfort you, but that is not evidence it is true. This is why chiropractic is, like so many alternative therapies, a form of faith healing rather than scientific medicine. We are all entitled to our metaphysical beleifs and the comfort they provide, but when we use them as the basis for deciding how to treat diseases, we get bloodletting, excorcism, and all manner of ineffective or dangerous nonsense. I prefer to base the therapies I provide for my patients on science rather than metaphysical, mystical forces.
mmmmm..funny you should mention ‘bloodletting’ because this was an accepted medical practise, for centuries…and it caused many deaths, and infections…leeches became the prereferred option later, because the ‘side effects’ of treatment, did not prove so hazardous. Other historical dangerous nonsense, in medicine…included the failure to learn about infection control from the midwives, in the 18th century…risky use of xray, for all kinds of diseases in the early 20th century…thalidomide prescribed for morning sickness, and the resultant deformations, in the 60′s and 70′s, not to mention the wholesale removal of tonsils, and adenoids, and other proceedures which are now largely abandoned too.
Do you really know the number of medical treatments which are proven ‘scientifically..and how many drugs that were generally recognised as safe, which are removed from the safe list every single year.??
It makes interesting reading.
You are completely missing the point. Bloodletting was justified for all that time by the same poor epistemology, namely tradition, anecdote, and personal experience, as is currently used to justify alternative medicine. It was only recognized as ineffective when more reliable standards of evidence were adopted. Likewise, all the harmful practices you cite were recognized as harmful and abandoned because people examined their effects scientifically. In contrast, alternative medical practices are claimed to be safe and effective because they are traditional or because people have used them and have the impression they work. Proponents if these approaches refuse to abandon then no matter how much scientific evidence accumulates against them.
So you have scientific medicine, which is imperfect but does alter it’s practices in light of new evidence, and you have alternative medicine which view opinion and the longevity of a practice as sufficient reason to continue that practice regardless if how demonstrably unsafe and ineffective it may be (just think glucosAmine, ear candling, energy medicine, faith healing, homeopathy, and many many others). So your tu quoque fallacy argument fails.
Sent from my iPhone
It has been said that the purpose of an education is to replace an empty mind with an “open” one…. and until we can grasp this concept, little discovery occurs because we hold tightly to certain beliefs, even “scientific ones” like the flat earth theory, it was good for 5000 yrs, or so. Try to remember how much we all used gravity…before Newton “discovered” it…for example. It may well be that much is yet to be revealed, in science, and to act as though, it cannot be used, or trusted, until fully explained…is a little limiting. Psychiatry, remains unexplained..scientifically, as does the power of the mind in healing… think of grief, and loneliness, fear, and pain….these elements are quite hard to evaluated “scientifically”… so perhaps we can grow in a philosophical sense, more if we cooperate, and learn together, rather than take this hard line …black and white position…
I wonder if you have met and talked to many Chiropractors, and also Vet/Chiropractors..to see what things they may be able to share with you, to increase your understanding, and knowledge. It may lead to the capacity for greater service to the community, which is the real goal of everyone. An open mind, surely is a gateway to learning, understanding, and greater contribution.
Science is a methodology by which we separate fact from fiction. It is not a belief system.
It’s interesting that the author of this blog, who apparently thinks that chiropractic shouldn’t be taken seriously, nevertheless works for an animal hospital that features a link to the services of a chiropractor.
I have edited your comment to remove my name and practice since, as I explain in my FAQ, I want the focus of discussion here to be about ideas, not about me.
That said, the general point you make is perfectly legitimate. I work at a large practice (21 vets), and I am not an owner or manager. Some of my colleagues share my skepticism about chiropractic and others do not. I personally explain to interested clients the limitations of the available evidence and my concerns about the underlying theory and the safety of chiropractic, and I do not recommend it for my patients, nor do I supervise chiropractic treatment. Just as I am free to do this, my colleagues are free to educate their clients and recommend those treatments they prefer as they please. There are differences in opinion on many subjects in our profession, and contrary to some of the accusations made against me, I am in no position to dictate that my colleagues practice according to my opinions. All I can do is educate and inform as much as possible, which oviously I am doing here and which I also do on a daily basis in my practice.