Chiropractic–The More Research We Do, The Less Reason There is to Believe it Works

In my previous articles about chiropractic, including a recent review of veterinary spinal manipulation for Science-Based Medicine, I have acknowledged that despite the nonsense of the theory behind chiropractic (the non-existent “vertebral subluxation”), there is at least some evidence in humans that it can be as useful for lower back pain as conventional therapies. However, some reviews have questioned whether the effect seen is clinically meaningful. Now, in an apparent example of the Decline Effect in action, the latest Cochrane review update has further downgraded the effects of chiropractic from statistically but not clinically significant to non-existent.

Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low back pain: an update of the Cochrane review. Spine (Phila Pa 1976). 2013 Feb 1;38(3):E158-77.

This review added 26 research studies involving over 2600 patients to the studies previously reviewed. Of these, 6 studies (30%) were at low risk of bias based on the quality of their execution. Spinal manipulative therapy (SMT, i.e. chiropractic) was compared with fake chiropractic, other inert placebo therapies, and other therapies thought to be beneficial for acute lower back pain as both the primary and an added (adjunct) therapy. The review concluded:

SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies.

In other words, when all the studies done are taken together, there is no evidence chiropractic has a benefit for acute lower back pain. Any other therapy, including placebos known to have no effects at all, is just as good.

The authors, as always, acknowledged that many of the studies were of poor quality, and they suggested that further high-quality research could affect this conclusion. But despite decades of intensive study, and widespread use, chiropractic is still unable to demonstrate its value for even the most plausible and seemingly appropriate use, treating back pain. The more evidence we collect, the less reason there is to believe this therapy is worth trying.

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44 Responses to Chiropractic–The More Research We Do, The Less Reason There is to Believe it Works

  1. Adrian Stone says:

    If a meta analysis researchs poor quality studies, then the validity of the results is questionable. Rather than scan the Cochrane database continuously why don’t you survey some chiropractic patient and visit some clinics to assess the results for yourself. You might be surprised.

  2. skeptvet says:

    You seem to be under the misapprehension that anecdotes and “clinical experience” (which is just anecdotes involving doctors) are somehow more reliable than controlled research studies. While the study quality is not great (due entirely to the choices of the chiropractors conducting the research, by the way), it is still a higher level of evidence than uncontrolled observations and testimonials. As I’ve made clear before, if we use such anecdotes to decide what works in medicine, then everything must work because every therapy ever invented has been able to produce testimonials claiming miraculous results. Which is more likely–anecdotes are unreliable or every therapy ever tried works?

  3. Russ says:

    If you are going to blog about an article, could you please present the entire point. The conclusion that you quoted was incomplete. In its entirety:

    “CONCLUSION: SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies. Our evaluation is limited by the few numbers of studies; therefore, future research is likely to have an important impact on these estimates. Future RCTs should examine specific subgroups and include an economic evaluation.”

    The author clearly states that their article was limited and needs more research. Instead of pointing this piece of evidence out, it was omitted which allows you to build your case that Spinal Manipulation doesn’t work. I would also like to point out that this study took in to consideration spinal mobilization studies, which are NOT spinal manipulation. I’m not sure how that data would change this, but it is not part of the modality being assessed. Please stick to the facts of evidence.

  4. skeptvet says:

    Despite your tone of outrage, the caveat changes nothing about the conclusions. Almost every review ends with the call for more studies, so should we simply ignore all conclusions followed by such a call? I think the bigger picture here is the lack of convincing evidence for the existence of the main theoretical foundation of chiropractic (the vertebral subluxation complex) or for clinically meaningful benefit for any condition (except MAYBE lower back pain) despite intensive research over many decades. The facts seem to speak quite loudly and clearly for themselves, and they say that the claims made for chiropractic are unsupported by good quality research evidence.

  5. Kevin Rindal says:

    Here is a good study for you to consider, it was recently published in the Spine journal. I do believe it would be helpful for you also to mention that a majority of the Physical Therapy and Doctors of Osteopathy professionals in the United States, and much of Europe, perform spinal manipulation on a daily basis. Are they quacks as well?

    von Heymann WJ, Schloemer P, et al. Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain. Spine 2013;38:540-548.

  6. skeptvet says:

    I have said numerous times that despite the lack of evidence to support the theory of the VSC, there is some evidence spinal manipulation is useful for lower back pain. The most recent systematic review found both positive and negative studies. While the one you cite is positive, others are not, so overall the evidence is mixed. It is reasonable, then, to consider spinal manipulation for back pain, but it is also possible that it is not a reliably effective therapy. I’m sorry if that conclusion conflicts with your beliefs, but that is what the current best evidence supports.

  7. Kevin Rindal says:

    Thank you for your reply. Could you also please comment on my question about Spinal manipulation and Physical Therapy and Osteopathy? You are talking about a procedure and then applying this directly to one profession to discredit the profession. Spinal manipulation is one of the most common procedures performed by Physical Therapists and many Doctors of Osteopathy.

  8. skeptvet says:

    I’m not sure what there is to reply to. If you are suggesting that because lots of folks believe spinal manipulation is useful this somehow validates chiropractic theory of practice, that’s simply not true. The number of people who believe in something is not a reliable guide to whether or not it’s true, for one thing, and for another “spinal manipulation” is a catchall term that refers to lots of manipulative therapies other than HVLA “adjustment” of supposed subluxations.

    As I’ve already said, the evidence is mixed but does suggest some value to manipulation for lower back pain. It also shows there is no such thing as the vertebral subluxation complex and that chiropractic manipulations are useless for every other use in which they’ve been tested. If you are asking whether I think using spinal manipulation to help treat lower back pain is quackery, then the answer is no (though I think it is not yet clear if it actually works). If you are asking whether I think the theory and practice of chiropractic in general is valid, again the answer is no. Does that answer your question?

  9. Vogel says:

    The short answer Kevin is that chiros are indeed quacks. They use a mixed bag of techniques, most of them (and of all of the effective ones) borrowed from the medical and allied health fields (e.g., physiotherapy and rehabilitative medicine). The only principle that is unique to chiropractic practice is the concept of the vertebral subluxation complex – this is the fundamental concept on which chiropractic is predicted, and is scientifically unsupportable (i.e., complete and utter BS).

    What chiros offer, in addition to their idiotic belief in the VSC, is a feigned attitude of compassion (e.g., “I, the chiro, will listen to you, whereas your regular doctor won’t because he’s too busy and doesn’t care about you as a person” – nonsense!), a false promise to treat the patient “holistically” (in alleged contrast with “conventional” medicine, that allegedly only focuses on symptoms), a lot of conspiratorial finger pointing (i.e., highlighting occasional instances of medicine’s failures and then misleadingly attempting to use this as evidence of the evidence of chiropractic’s benefits), the use of bogus diagnostic devices (e.g., muscle testing, useless gizmos with blinking lights that are supposed to detect thermal anomalies on the exterior of the spine), pushing worthless overpriced vitamin supplements, and defrauding medical insurance companies.

    So let’s revisit that initial comment back in April by Adrian Stone, who suggested that we shouldn’t pay attention to the scientific meta-analyses that time and time again have shown that the benefits of chiropractic have either been grossly exaggerated or do not exist at all, and that instead we should survey a single chiropractic patient to gain real insight into the field. OK, then – my experience is as follows.

    (1) Every chiropractor I have ever encountered – without exception – is someone who was a subpar college undergraduate student and could not gain entry into the first 3 or so health professions on their list (medical, dental, veterinary, research grad school, osteopathy, etc.) because of low grades and lack of ability, so they chose chiro as a last resort default.

    (2) Every single chiropractor I have encountered has primarily tried to promote their profession not on the basis of the merits of chiropractic but on the perceived deficiencies of the medical profession. In every case, this has involved conspiracy theory-mongering, baseless mudslinging, and lots of straight up lying about the aims of medicine and MDs. One chiro’s who I had visited had his office festooned with newspaper clippings of medical horror stories. The chiro was either too stupid or too dishonest to recognize the fallacious logic – e.g., a surgeon forgetting to retrieve a sponge from a patient’s abdominal cavity before being sutured up does not in any way establish the legitimacy of chiropractic).

    (3) Every single chiropractor I have encountered uses some sort of unvalidated or thoroughly discounted/discountable diagnostic device (e.g., thermal detectors) that has no value whatsoever, other than as a means of coercion to deceive a patient into committing to long-term chiro care (i.e., long-term meaning until the insurance runs out). In addition, they expose patients to radiation needlessly by performing x-rays to detect subluxations that do not exist even in theory.

    (4) Every single chiropractor I have encountered has shown me a wall chart depicting how VS in different areas of the spine and peripheral nerves can cause a plethora of systemic diseases; the implication being that the chiro can magically relieve virtually any disease (e.g. diabetes, epilepsy, heart disease, etc.) by manipulating the spine. This is a deceptive and dangerous oversell. It’s not just unscientific; it is delusional.

    (5) Every single chiropractor I have encountered has offered some conniving means to defraud my health insurance company; typically by telling me that I can basically get back massages covered for free, when in fact, insurance should not cover this. Amazingly (but not at all really), the recommended course of treatment always seems to last for precisely the same number of visits as my insurance company is willing to reimburse for.

    (6) Every single chiropractor I have encountered has plugged some form of overpriced nutritional supplement, typically one of the forms of ridiculous woo peddled by disgraced Utah-based pyramid scheme companies like Monavie, Xango, Protandim, etc. One chiro even gave me a chewable papaya pill with vitamin C and said it was a powerful painkiller. Worse yet, chiros typically serve as the kingpins in the distributor organizations for these companies; they serve as spokespeople, hard-selling the deluded notion that things like acai berries can cure cancer, for instance, and they conduct pitch meetings to recruit new participants.

    (7) Chiros rely on the placebo effect and they do everything they can to heighten its impact; e.g., playing up patient expectations, relying on regression to the mean, leveraging the Hawthorne Effect, etc. The game they play works like this: anything that goes right after a chiro treatment is due to the chiro treatment; anything that goes wrong was just a coincidence; if the chiro treatment didn’t work, it’s only because the patient didn’t give it enough time or they just need more treatments.

    I am yet to meet a single chiropractor with an ounce of integrity; i.e., one who would admit that among the mixed bag of techniques they use, the ones that work are borrowed from medicine and allied health fields, while the ones that don’t work are those that are unique to the chiro profession (i.e., everything based on the concept of the VSC).

    Needless to say, I haven’t gone near a chiro for well over a decade; since my younger naive days before finishing college. Chiros are useless for pretty much anything but a good laugh. The public would be better served if the entire chiro profession was eliminated and handed back to the allied health professionals (physiotherapists and rehab medicine specialists) who haven’t been indoctrinated with anti-scientific BS and haven’t sold their souls.

    So there you have it — chiro fails on every level. It fails to meet scientific standards for validity and it fails miserably based on empirical observation.

  10. Kevin Rindal says:

    You have still not addressed my question regarding Physical Therapists and DOs performing SMT on joints lacking mobility and have focused on “beliefs,” which I am not addressing in my question.

  11. skeptvet says:

    a majority of the Physical Therapy and Doctors of Osteopathy professionals in the United States, and much of Europe, perform spinal manipulation on a daily basis. Are they quacks as well?

    This is the only question I see in your original comment, and I have addressed it. Using spinal manipulation to treat back pain may or may not be effective, but it is not quackery, so if this is all these folks are doing, then they are not quacks. However, treating vertebral subluxations or using spinal manipulation to treat other problems is quackery, so if they do these things they are practicing quackery. I’m not sure how much clearer I can be.

  12. Vogel says:

    That’s right Kevin, I glossed over that myopic aspect of you question because it’s trivial and distracts from the subject of this article as well as the broader issues involved with chiropractic. Go back and address what I wrote (i.e., the many compelling lines of evidence that weigh against chiropractic) and I might pay more attention to that particular detail. Notice that I addressed the broader issue you raised about what does and does not constitute quackery, and explained quite clearly why chiro’s are quacks.

    Even if physical therapists and DOs were to perform SMT on immobile joints, would that justify a chiros claim that his alleged ability to fix a VSC, which doesn’t exist anywhere beyond the chiro’s overly fertile imagination, can cure diabetes? Does it justify the chiro’s use of invalid diagnostic devices to coerce patients? Does it have any bearing on placebo effects, conspiracy/fear-mongering, insurance fraud, and the promotion of worthless products and pyramid schemes? Does it make up for the typical chiro’s subpar performance at the undergraduate level?

    Chiros, at best, are mostly anti-scientific purveyors of woo who borrow a few valid techniques from other allied medical health professions; all too often they just are pernicious predators.

  13. Kevin Rindal says:

    Vogel, sorry, I missed your comments up above, before my last post. I hope we have the opportunity to meet some day because I might be able to show you a different side of Chiropractic and could definitely introduce you to others who are exceptional healthcare providers. I was an exceptional student every step of the way through my education (and outperformed several of my classmates who are now MDs), use practices that are evidence based, and receive dozens of referrals every month from some of the top Medical Doctors in the area that I practice because they are well aware of how I practice, which doesn’t at all fit the description given above.

    Again, I thank you for taking the time to have this conversation.

  14. Vogel says:

    Thanks, but I don’t want to meet you. The beauty of evidence-based medicine is that it doesn’t require me having to meet you face to face; all you have to do is put evidence on the table. If you believes in woo like VSCs, then you are not an evidence-based practitioner. If the only treatments you apply that have any value are borrowed from allied medical health specialties, then we have them to thank, not chiropractors who waste time and money with spinal manipulations to fix something that doesn’t exist (i.e. VSCs). If you peddle supplements and anti-scientific conspiracy theories, then you are doing your clients a disservice. And if you don’t do any of those pernicious things, then you aren’t really a chiropractor; just in name only.

    I don’t give a fig about any claims that you make about referrals and your academic achievements because your claims are not evidence-based. Want to send in your transcripts and referral contacts for further consideration, then go ahead; otherwise don’t waste my time with such nonsense.

    I know the score all too well already. Most chiros (at least all of the ones I have encountered) practice all of the deceptive tactics I mentioned above, including overselling their profession as a means to cure just about medical condition imaginable (not just lower back pain — pretty much the only area where chiro has shown even modest efficacy) . If you are that one in a million exception who doesn’t do these things, then what you are practicing isn’t chiropractic — rather, you’re a glorified masseuse/physiotherapist who has the temerity to call themselves “doctor”. There’s an obvious reason why universities refuse to teach your particular brand of — because it’s pseudoscientific BS!

    You don’t even have the honesty to take a cold hard look at your profession and admit that the indictments I made are accurate and truthful. Where is the pause for self-reflection and self-criticism? Instead, you gloss over all the glaring deficiencies in chiropractic and proclaim yourself to be unlike all the rest. Until you can grapple with reality, you will continue to be a liability.

  15. Anthro says:


    I appreciate your attempt to have a civil discourse and make your case and I also winced a bit at Vogel’s reply, but while his tone is a tad strident, I can’t argue with his premise.

    You may not engage in every practice Vogel outlines, and you may have freely chosen chiropractic even though your grades would have allowed real medical training, but you are most emphatically still a chiropractor (meaningless term, really), not a “healthcare provider”, exceptional or otherwise.

    Kindly tell me who are these MD’s who refer patients to you so that I can make sure I do not see them when I actually have something wrong with my back. My physicians (over a 30-year span in several states) send me to the Physical Therapist or recommend a trial of NSAID’s as a first step when I have such issues, but not once has an MD referred me to a chiropractor. Just lucky, I guess.

  16. Vogel says:

    The stridency comes out involuntarily whenever I have to deal with voodoo specialists like Kev. I was just looking over some POS document he threw together as part of a PR effort for SMT.

    The way he cherry-picks studies and avoids discussing any negative research findings shows that he has no objectivity on the matter. He has no qualifications (or apparent ability) to conduct such an analysis, which partly explains the hamfisted execution.

    Just another dumb jock that settled into chiro college because of lack of options (and calling it chiro “college” is an insult to college; like calling Fagan’s pick-pocketing academy “Grifter University”.

  17. Say what says:

    Wow Vogel, I appreciate your passion on a topic. But did you get picked on a little bit as a kid? Are you willing to criticize someone to their face or do you rely on being tough sitting behind your computer? Anecdotal stories burn folks like you, who are buried in their science books. I treat people who either get better in a reasonable amount of time or are referred to respectable orthos down the street. I don’t prey on people. I barely even advertise. I don’t recommend excessive treatment plans. I have never overcharged an insurance company. I don’t use those gimmick devices. I don’t expect to change your mind. Everyone should do their own research and make decisions based on what they find. But you are spewing hate towards an entire profession. When someone is having migraines for years and after one adjustment, no longer has migraines, I guess I can’t back it up scientifically. But that person, who has tried EVERYTHING is very happy. And that’s how I stay busy.

  18. Rick Araya says:

    Hey Vogel…I stumbled across your comments today…

    I don’t do any of the things you say all chiros do.. I think the part about admitting all you do belongs to another profession is interesting. I do just adjust the spine. I don’t manipulate. I was taught there was a difference. I do find vertebra that aren’t moving, correspond to taunt and tender fibers, appear to be malpositioned and I call them subluxations because those are the words I was taught. It may be a non-allopathic lesion to you but to me it’s something that an adjustment may help. I allow my patients to choose their level of care and determine if it’s helping. Any business that uses it’s professional leverage to coerce would be improper! Here’s my real point:

    I don’t want chiropractic to become medicine. I don’t want accupuncture to cease to exist. I don’t want massage therapists to go away. I don’t think nutritionists and naturopaths are terrible. I don’t want to morph into what is currently accepted only for acceptance. You have only 1 option drugs and surgery. Drugs are a racket. Surgery is fine when you need it but a lot of unproven things going on in our hospitals too. That’s just true. I wish it wasn’t. That’s not bashing it’s just looking at things through the same lens.

    I will continue to ethically take care of the people who show up and do what chiropractors do. I will look for the areas of the spine that may respond well to the adjustment and have them do what they are going to do in the body which isn’t always just musculoskeletal. (sorry for the awkwardness of the statement but trying not to recruit terms that below to other professions and not use the word that you don’t like!) Thank you for the call to ethics and decency. Thank you for the call to being the profession that you are. Thank you for the reminder that a chiropractor has to be a chiropractor that practices chiropractic because it helps a lot of people and the public wants it. Chiropractic will always have trouble getting the research done. Not one of the 15 new people to my office asked me about research this week. Still, less sensationalism, more service and demonstration and allowing the people to notice how chiropractic helps them would be great.

    Be happy anyway. Rick

  19. skeptvet says:

    Not one of the 15 new people to my office asked me about research this week. Still, less sensationalism, more service and demonstration and allowing the people to notice how chiropractic helps them would be great.

    No one ever asks to see the research when consulting a hoemopath or a psychic either. The fact that people believe you are helping them by adjusting their spines and don’t care whether or not there is scientific research to support that doesn’t mean what you are doing is anything more than a placebo. It may be (and I actually think in some cases it is), but that is not decided by whether or not people believe in it, because that leaves us having to accept everything people believe in as equally valid.

    Ciro has been around and research for 150 years. If the subluxation existed and caused disease and if adjustment reslved a subluxation and prvented or cured disease, it really should be so difficult to demonstrate scientifically in that amount of time. People scoffed at the idea that ulcers could be caused by a bacteria, and 20 years later the two proponents of that idea won a Nobel for it because they proved it through science. If an entireprofession can’t demonstrate scientifcally that their core theoretical idea is real in a century and a half, I don’t think we can blame science or Big Pharma for that.

  20. Art says:

    I’m still waiting for that study that compares a chiro “adjustment” to a good back rub from grandma. I’m putting my money on grandma.

  21. Joje says:

    You’re probably going to remove this comment when you are moderating.
    I can get on board with your skepticism on acupuncture and herbal remedies, but on chiropractics? It’s idiotic. I’ve been suffering from neck and back pain for years and only until I started getting sublixation adjustments that I felt pain-free, more focused, and taller. It makes total sense, though I’m not a physician, that a person’s spine, while out of whack, will cause all the nerve endings around it go out of whack as well. And chiropractics straighten the vertebrae out so that all the nerves and muscles surrounding it go back in their proper positions, resulting in less pain, less pinching, and less collapsing of connective tissues.

    I love how everything you say is somewhat “there is no scientific evidence that it works,” – not sure where you’re getting your sources but I can hardly believe it’s true. My friend who attends Havard Med are studying effects of Eastern medicine. You’re skeptical, I get it, but I think you’re actually doing people harm. Then again, you have the right to make claims.

  22. skeptvet says:

    The problem is that as natural and compelling as it is to believe that feeling better after chiropractic means chiropractic works, it really doesn’t. For thousands of years, people felt better after bloodletting, purging, and innumerable other therapies that didn’t actually help them. The only reason we bother to do scientific studies at all is because our individual experiences aren’t a reliable way to prove anything. There are lots of reasons you might feel better after chiro treatment that have nothing to do with the effect of the manipulation on your body.

    That said, I have always said there is evidence that people do feel better after chiro for lower back pain; about as much better as they feel after phystical therapy, massage, and lots of other treatments. The prblem is the notion of the subluxation is complete nonsense. After 150 years, no one has ever shown that chiropractors can reliably identify one on an exam or an x-ray or in any other way. So if the manipulation makes you feel better, it’s not because it’s reducing a subluxation. There are many possible reasons why it might work other than this theory, and plenty of chiropractors have abandoned the subluxation idea alltogether. And while I realize you won’t see it as possible, one big reason is the placebo effect.

    If chiros confined themselves to treating lower back pain, I wouldn’t pay much attention. But neck manipulation has not been shown to have benefits and does have small but serious risks, and the pile of other nonsense they often espuse (rejection of vaccines, treatment of infecions, cancers, and other non-musculoskeletal diseases, colonics, applied kinesiology, herbal therapies, etc) are all potentially quite dangerous. So I have to disagree with you in that warning people about the risks and informing them about the limited evidence to support what chiros claim is not doing harm, it is the false claims and ineffective or untested practices of chiros that puts people at risk.

  23. Richard Handler says:

    Pretty aggressive responses to posters. I hope you aren’t trying to attract readers. You’re a vet chiming in as an expert on human medicine and studies? Did you, as Vogel indicates, have trouble getting into med and dental school?
    Vogel, you need to take a chill pill and remove “I’” from your favorites. Get off your high horse and be respectful for a change. You might notice with a positive outlook you benefit from the placebo effect of shrinking your prostate and getting erections once again.

  24. skeptvet says:

    I only respond aggressively to people who make hostile and irrelevant remarkes, like “have trouble getting into med and dental school?” Vacuous snarky nonsense like that doesn’t have anything to do with the substance of the debate here. If you have evidence or reasoned argument to offer, you are welcome. If you just want to snipe at people who annoy you, that doesn’t contribute anything useful to the discussion.

  25. Canskeptic says:

    In my experience, it was harder to get into vet school than med school, and the top few of my students were the ones that got in.

    If you understand how science works, how to dissect studies, how to identify authoritative sources, and how to think skeptically, you don’t need to be a subject area expert, though it helps.

    Veterinary medicine isn’t worlds apart from human medicine, too.

    It’s hard to remain perfectly civil when presenting scientific evidence, only to have trolls counter it with what they mistakenly think is persuasive evidence to the contrary: anecdotes, testimonials, denigration of science, conspiracy theory (research debunking your flavour of woo is paid for by Big Pharma, or Big Medicine), or misdirection (yeah, but we spend more time with patients, treat causes not symptoms, or other irrelevancies).

    The internet is full of people who are argumentative and prolific typists, but lack the critical thinking skills and factual information to make any positive contribution to a scientific debate. When they become persistent and ubiquitous, it’s hard not to get a bit sharp, lol.

  26. Jacqueline billington says:

    It is so nice to hear an educated view which is based on scientific, empirical evidence rather than anecdotal and biased evidence only. As a bat research scientist and experienced horse owner and trainer, I am frustrated by the lack of truths told by those who have a reason to endorse a certain method of complimentary therapy. As I am an open minded person, I have still tried out various kinds therapies over the years and with my ten current horses, who are all in serious training at home and I have only found that a competent deep muscle massage therapist can make a really positive difference to the horses movement, which the horse itself can clearly feel, both during the massage and for a relatively long period of time afterwards. If a recommendation is made, I would chose to hire the individual based on qualifications and experience, then I watch to see if the horses can really feel a positive change.

  27. Jo Amsel says:

    I can only give two experiences of taking dogs to my own chiropractor who certainly eased my back pain. One was a dachshund belonging to a friend. He had 2 years previously, fallen out of a Land Rover and since that time had screamed when trying to go down the stairs. The vets had drawn a blank and said he would have to live with it. After hearing him scream, I offered to take him with me the following week. Boy she made him yell. Said to put him on the stairs when I got him home, no problem, no screaming, never did it again and was a lot more active when out on walks. Second time was my own whippet that started limping on a foreleg. This went on for months. Did as my vet said,rest anti inflammatories etc. but everytime it started within a day or two. Took her to the same chiropractor who manipulated her neck and spine. Got her home, sound and stays that way. Now this may be anecdotal but t is not imagined if exaggerated! We have to be really careful not to dismiss all manipulation as quackery.

  28. Jo Amsel says:

    No I am not surprised about that ( for instance I know people who swear by homeopathy for their pets ) and I know there is quackery, a lot of it,but my own vets now suggest chiropractic when they have come to a full stop but I can only say it’s easy to be dismissive when hard evidence is difficult to find. In both these cases you could argue that it was mere coincidence rather like patients getting better after a course of drugs when they would ha e gotten better without the drugs, you just can’t prove it.

  29. skeptvet says:

    Well, you can prove it if you do the right kind of research. The problem with chiropractic is that a lot of research has been done, and most of the time if there is good control for bias then the results aren’t very impressive. There are some decent data for idiopathic back pain in humans, though no better than for conventional treatment, but for the most part chiro has had the opportunity to prove a lot of the claims made for it and hasn’t generally succeeded.

  30. Jo Amsel says:

    No you can’t prove it! You can’t prove that the patient will have gotten better without drugs anyway. Explain how you would do that? You cannot prove that the one treatment on the dachshund – where she obviously found the part that hurt and manipulated it – would have gotten better suddenly on that day?

    There is a lot of nonsense chiropractic, claiming all sorts but those that do some manipulation may well work ( certainly worked better in my neck than conventional physio). Problem with chiropractors and the like is the lack of differential diagnosis which can be dangerous and the mumbo jumbo and the fact that in the main it actually doesn’t do what it says it does.

    Problem with sceptics is that they cannot really accept anything that is anecdotal. It all must be evidence based science but so much evidence based science is very poor science indeed if not downright manipulated .If it wasn’t we wouldn’t have to have banned so many ‘safe ‘ pesticides and ‘ safe ‘ drugs etc. etc. Sorry off topic! On to your BARF diet next : )

  31. skeptvet says:

    The way one proves that a therapy works better than an alternative, or better than doing nothing, is to conduct a controlled clinical trial comparing that therapy to the alternatives. Ideally, several trials with independent investigators and different sets of bias. If there is an effect, it will be apparent, and if there is not, that will show up too. If all the evidence shows that a therapy is a placebo, then you can say with a high degree of confidence that any patient who improves after using that therapy is not improving because of it. 100%, no, but pretty darned high.

    This isn’t a perfect system, but it’s proven far more reliable than anecdotes, which is why scientists give little weight to anecdotal evidence. We relied on uncontrolled observation for tens of thousands of years and made less progress in technology and health than we have made in the last 200 because we have a method of figuring out how things work that is more effective.

    The problem is not with science or skeptics but with the pervasive and hard-wired tendency to prefer anecdote and personal experience to data. If all the evidence in the world shows a therapy to be BS (such as homeopathy), yet you try it and feel better the next day, you’re going to believe in that therapy anyway, because the alternative of accepting the unreliability of your own experiences is just too difficult. That’s not a flaw in science but a feature of human reasoning.

    As for bad science, sure, there’s plenty of that around, including most generated by proponents of alternative therapies. But the existence of bad science doesn’t invalidate science any more than the existence of quack medicine makes all medicine quackery. It is a fallacy to say that if science gets some things wrong in the short term that we are justified in tossing it out the window and relying on anecdote, and it would be a bad choice to do so. Yet that is what advocates of most alternative therapies ultimately ask of us. They claim science is fine except when it argues against something they believe and then they say we have to accept that claim without or despite scientific evidence. That’s pure bias and self-interest.

  32. Jo Amsel says:

    Not disagreeing with you on this, I cannot hack homeopathy because there is no sense behind it at all but of course there is a placebo effect. However medicine has a tendency to change its mind whereby things that appeared to set in scientific stone get changed. My husband studied medical research papers as part of a 2 year study course and found many of the, were badly done yet taken as meaningful. For instance, it is common practice to insist that people finish their course of antibiotics but there is not proof it is necessary after the symptoms have gone or taking proton pump inhibitors helps to prevent damage to the stomach lining when taking anti inflammatories. No real evidence for that either. I broke my ankle recently ( minor fibula break )and was prescribed 6 weeks of anti clotting agent by injection by the Consultant.I looked up the research papers, all of them and there was not the slightest reason that I should have been given them and in fact was more risky for having a brain haemorrhage than the extremely slight chance of a clot.yet how many people would have looked that up. As it so happened the Registrar agreed when I went for my X -Ray 2 weeks later. scepticism works both ways! As a vet I assume that you do not recommend joint supplements containing glucosamine etc. since of course there is little to show they work on humans and and nothing at all to show any effect our pets. Yet many vets do sell them. My point is that there was a physical action in what the chiropractor did and that action did have a effect so we should not throw the baby out with the bath water and claim all chiropractic is of no benefit.I had another dog with a sticky cervical facet joint. He would go in unable to move his neck which was in spasm and come out back to normal. Of course the relief was only temporary but lasted up to 3 months. When the chiropractor was ill, I took him to my vet who suggested Metacam. One small dose killed the dog. He was one of the unfortunate ones where despite flushing him through for 2 days, it had done permanent damage to his kidneys. I should have stuck to the diazepam until he could be seen again!

  33. Sherri says:

    While I appreciate your science-based approach, I think you should re-evaluate your stance on animal chiropractic.

    Individual cases can be dismissed as anecdotal or lauded as experience, so FWIW, here’s my experience: My dog had two episodes of screaming pain almost exactly 1 year apart when she was about 1 and 2 years old. After the second, the vet took an x-ray and found that at the juncture of first vertebrae after the tail and the first of the tail, calcification had formed. The vet’s conjecture was that when she was turned around and licking herself (which she was doing when she started screaming), the classification had broken loose. The vet recommended surgery.

    Having seen poor or negative results from human friends’ spinal surgeries, I sought out and found a chiropractor trained at a human program and who then received the training in animal chiropractic. Not only has this treatment (about 3 x’s / year at $40 per) resulted in no further episodes of pain (so far as I can tell, but surely the absence of the screaming episodes is a good thing), but I can actually see the improvement in the smooth curve of my dog’s back and in her gait (which is hard to describe, but she has less of a ‘folding’ side to side, and a more natural movement). I don’t make sweeping claims for chiropractic, but when I have neck pain, it helps me, and for this mechanical problem in my dog, it seems to have helped her at small expense, compared to surgery, and with no trauma.

    Surgery, for humans or animals, rarely underdoes the sort of double-blind scientific study that pharmaceuticals do. A famous study on knee surgery concluded, “the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.” Yet this continues to be a very common surgery!

    My personal conclusion is: 1) the so-called placebo effect is a power force in its own right that merits further study and understanding; and 2)while we pursue further studies of many modalities of treatment and strive for scientific rigor, we should keep an open mind. There are so many things about illness and healing that we do not understand.

    I know this is an old post, but maybe as folks search the ‘net for info on animal chiropractic, my comment may be of use.

  34. Lynne says:

    Exactly Sherri!
    “My personal conclusion is: 1) the so-called placebo effect is a power force in its own right that merits further study and understanding; and 2)while we pursue further studies of many modalities of treatment and strive for scientific rigor, we should keep an open mind. There are so many things about illness and healing that we do not understand.”

    I ran across this blog while researching health topics for my own dogs. Very interesting, but I find it disconcerting that the author finds holistic and homeopathic remedies totally unreliable. Luckily, my non-holistic vet doesn’t discount these. My experience is anecdotal, but it’s been over 30 years of dealing with one breed and some heritable health issues. A combination of western, proven medicine AND holistic and homeopathic supplements have helped most of my dogs live long and healthy lives.

  35. skeptvet says:

    What I discount is the reliability of anecdotes. There is a reason science has doubled our lifespan aften thousands of years of relying on anecdotes failed to do so.

    Actually, what you have is just a story, not evidence. Stories turn out to be misleading in medicine, which is why science has done so much better a job at extending and improving our lives. Did you know that dogs in studies of epilepsy medications have fewer seizures when taking placebos, for reasons that have nothing to do with the fake medicine they are given? Everything is not always what it seems.

    Why We’re Often Wrong
    Testimonials Lie
    The Role of Anecdotes in Science-Based Medicine
    Why We Need Science: “I saw it with my own eyes” Is Not Enough
    Don’t Believe your Eyes (or Your Brain)

  36. v.t. says:

    Homeopathy is a joke, all at the expense of the mark’s (oops, the ill-informed) pocketbook and gullibility, and worse still, at the expense of innocent pets who can’t tell you they deserve real, valid medical treatment, not snake-oil and fake promises. How I so wish people could lift one finger long enough to do real research (not Dr. Google) into the scam of homeopathy and it’s cousins in woo.

  37. Jo Amsel says:

    I have been on your site before ! I obviously need Vivitonin. ; )

  38. Individuals will have bad reviews about Google as well, do you think we are gonna stop using?

    Same way every individual have their own thoughts about Chiropractic care and i have personally seen cases of getting healed with Chiropractic care and i believe in this.

  39. skeptvet says:

    Negative reviews, like positive reviews such as yours, are all just anecdotes, and anecdote simply isn’t reliable. The failure of chiropractic to consistently prove its value in controlled scientific research says a lot more than all the anecdotes, for and against, that you could find.

    Why Anecdotes Can’t Be Trusted

  40. peter says:

    I would love to hear someone defend a branch of chiropractic called DNFT (Directional Non Force Chiropractic) where the chiro finds supposed subluxations based on a “leg reflex check” and fixes them by moving bones back into place with a simple thumb maneuver. As I understand what I am reading anyhow. Is this real or voodoo?

  41. Freddie says:

    I find it very hard to believe in the credibility of the science conducted on chiro. I see a lot of people say: ‘if chiro has been around for so long why hasn’t science demonstrated it’s positive effects?’
    Fair point, but all of you really should be asking: ‘is chiro treatment something which can be reliably tested scientifically?’
    The thing is with Chiro treatment is that they often use a mixed bag of other treatments. The best chiro’s out there will also recommend physio, perform massage on your muscles and work out the toxins with tools, and perhaps incorporate even more techniques. So point is Chiro treatment in isolation could be very ineffective, but Chiro combined with massage and other techniques suddenly becomes extremely effective.
    Anti-Chiro people can then obviously and fairly claim that the positive results of a holistic chiropractor are down to one or more of the other techniques used and not the manipulation itself. There is no way of proving that though, and just because physio is positively backed up by evidence based science for example, it doesn’t mean that physio made the patient better either, and I don’t think it is wise to assume that would be the case on a common sense basis either.

    So what is the reason why research is so poor on this, and why does physio treatment report as positive in scientific studies and chiro not?

    I don’t know for sure, but here are my guesses:

    1. Physio can treat people even if they don’t have subluxations, therefore assuming both treatments are valid, physio has more potential to show positive results, meaning the chance physio treatment comes back as statistically significant will be higher than chiro. In other words assuming most people do not have subluxations, chiro is going to be useless for most people whereas physio will be helpful for most people.

    2. The definition of a subluxation is wrong (doesn’t mean they don’t exist, just possibly in a different way to what people think), therefore a study can’t be setup with patients who have subluxations as there is no way of proving that the patients have them.

    3. A double blind study with a sham manipulation comparing to a real manipulation could be very difficult to produce anything statistically significant, especially with small sample sizes (in the literature) and due to points 1 and 2 both being contributing factors.

    4. How reliable are relative pain assessment surveys? When are patients asked these questions? How many times are they asked them? etc

    5. How can you accurately compare physio to chiro. For example, Physio can be prescribed to help a patient, but the frequency, length and intensity of physio is different to chiro. So how do you compare 1 session of chiro to 1 session of physio? Maybe 10 sessions of chiro are relatively equivalent to 1 session of physio for example. Or maybe 1 hour of physio is equivalent to 10 minutes of chiro. Or perhaps one could argue it takes as much chiro as necessary to treat the patient and there is far more variability in the number of chiro sessions required compared to phsyio sessions.

    6. Perhaps the best positive results from physio are less effective than the best cases of chiro (assuming subluxations were present in physio and chiro patients), but there are just very few of these cases.

    7. The variety and complexity of chiro treatment is arguably much much greater than physio treatment. In physio a specific exercise is asked to be done by the patient and they are instructed how to do it, some patients will do it different to others no matter how well they are taught, however the success of the treatment is mostly down to the patient than the practitioner, the patient puts in the work. However with chiro it is the practitioner who does all the work which means if there is only 1 practitioner in the study, the opportunity for a huge error to occur is large. You have to ask whether that practitioner is 1. good at his job and 2. performing one of many chiropractic methodologies which is an effective one.

  42. skeptvet says:

    all of you really should be asking: ‘is chiro treatment something which can be reliably tested scientifically?’

    If the answer to this question is “No,” then there is no reason to ever believe the claims made for chiropractic. A common strategy for implausible alternative therapies to avoid the burden of proof expected for science-based medicine is to claim some feature that makes them untestable– magical energies, individualized treatment, etc. The problems with this are that 1) it is a case of special pleading to avoid producing evidence and 2) it requires us to then accept scientific medicine only when it proves itself safe and effective through data while other approaches expect to be accepted on the basis of faith, anecdote, etc. It essentially shifts the standard of evidence to suit the desired claims, which is simple cheating.

    FWIW, the claims of Chiro, from b basic mechanisms to clinical effects, are all perfectly and easily testable, and the failure to find good evidence for them is not a matter of an untestable therapy but a therapy that most likely doesn’t do most of what its proponents claim.

    Chiro combined with massage and other techniques suddenly becomes extremely effective.

    Not really plausible, and if true then why would the Ciro get any of the credit? In any case, though, combined therapies and additive treatment effects are easily testable, and these haven’t been found either.

    a study can’t be setup with patients who have subluxations as there is no way of proving that the patients have them.

    Well, if we can’t test it because the people who claim to be treating it don’t actually know what it is well enough to enable a study, then why should we believe they can fix it? (or, for that matter, that it exists) You are basically grasping at straws, saying that if we can’t prove it it might still exist. So what? If we can’t prove it exists and we can prove the mechanisms and effects of other therapies, why waste time on this one? And even if we can’t prove the mechanism exists, if we can’t prove clinical benefits, who cares?

    A double blind study with a sham manipulation comparing to a real manipulation

    These have been done, many times, with adequate statistical power to show an effect if there were one to show.

    How reliable are relative pain assessment surveys?

    Just as reliable for Chiro as for lots of other pain control treatments that we can show work.

    I could go on, but you are basically making the argument that because we can never absolutely prove a negative we should take seriously claims that have failed to show evidence they are true despite extended effort. This is a wasteful and inefficient way to utilize science, and it’s all an excuse not to give up on something that people believe in just because they believe in it, regardless of how unlikely it is to be true and how poor the evidence is.

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