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Eric McKillican
1st August 2000, 14:22
I have seen the quackwatch site,it is full of unsubstantiated opinions which holds every non medical health profession to be quackery. Anyone with half a brain looks at this site and sees it for what it is. A poor attempt at discredeting the alternative healing arts. If so many alternative healing professions were that dangerous and unethicle then their actions would have been exposed much sooner then this wib site. I say look at the track record of each profesion and make your choice based on educated fact not someones warped opinion. Heres two facts that cannot be discredeted: 1, chiropractic works because it allows the body to do its own healing from with in. 2, if medicine worked for creating healthy people then we would not be plagued with disease, illness and death.

As for your anti-inflamatories and cortico steroids. You may be feeling better by puting these chemicles into your system, but at what price? Your body parts can only take so much chemical interferance to its normal function. According to JAMA April, 98; 106,000.00 people DIE every year from properly prescribed drugs and another 2 million suffer from adverse reactions. Drugs need to be used responsably and only when needed. Not taken like candy at every litle ache and pain. I bet they did not tell you that those three cortizone shots into your spine will excelerate the degeration process and you will end up with a chronic unrepairable condition, some trade off for temporary relief. If more people had more faith in the bodies inborne potential to heal, we would not be in the crisis we are in today.

Eric McKillican D.C.

1st August 2000, 14:30
I don't disagree with holistic health approaches. I think there are a lot of benefits to this. However, medical science is just that, a science. It involves experimentation, and unfortunately, there is no one reaction for every treatment in different individuals. Some respond, yet there will always be some small minority which don't.

As for the quackwatch site, it appears to be very well documented and objective. The cult-like posturing of chiropractors aside, there is a lot of evidence that chiropractic medicine is dangerous in many hands. Despite your negative feelings toward the AMA, I would trust the members of that organization over chiropractors any day. Personally, I prefer the scientific approach to health over the mystic.

Eric McKillican
1st August 2000, 18:40
You think medicine is science! Go back to basic chemistry and you will find science. Science is about 100%reproducable results every time. i.e. measured amount of product A + Measured amount of product B yealds product C. So since you and I agree that diferent reactions happen from person to person with drugs, you might also see how unscientific the medical comunity really is. Medicine is the practice of trial and error and cover up not science. Take prozac for example, the origional studies have just been released, and it was shown that the manufacturer covered up the simple fact that prozac made people suicidal. The manufacturer leaked this information since the patent was about up and Prozac was going to be available for generic use. But don't worry prozac users because the manufacturer now has a newer and better replacment drug for depression. (and they say it is safe too) And that's science? Don't get me wrong I do not hate the medical profession. I now they do amazing things for people who have no other options. The entire profession is a reactionary, disease, sick based profession and they are the best at what they do. Thank god they are there for those people, who have let themselves get to that point in their health. But, you ask for the medical profession to show you results with HEALTH and they have none.

Next, it is not chiropractic mecicine, it is chiropractic. To relate us to medicine infers that we do what they do, crisis care. I can sum up chiropractic into four simple concepts:
1: the body is a self healing self regulating organism.
i.e. cut the finger of a person, it heals. cut the finger of a coarpse it dosen't. It is life it self that heals!
2: The nerve system is the controling system of the body and is responsable for every function and expresion of the body.
3: interferance to the nerve system results in incoordination and imballance to the body and its functions.
4: The job of a chiropractor is to locate and correct this interferance. Thus restoring the body back to normal balance.

Some chiropractors choose to add to their practice the use of adjunctives, such as therapy, nutrition, accupuncture, ect. The use of these modalities is not unique to chiropractic and can be found in many different health care professionals practices. The only thing that makes a chiropractor distinct and unique is their ability to locate and correct the vertebral subluxation. There is nothing mystic about promoting a healthy environment for which the body is aloud to heal to optimum.

Studies are there supporting my calims, Chiropractic has hundreds of thousands of case studies, thousands of peer reviewed studies and hundresd of medical (M.D.) peer reviewed studies. All which support our guidlines and philosophies. If you would like a list of referances all you need to do is ask.

Eric McKillican D.C.

Jerry O'Brien
1st August 2000, 19:57
Originally posted by Eric McKillican
You think medicine is science! Go back to basic chemistry and you will find science. Science is about 100%reproducable results every time. i.e. measured amount of product A + Measured amount of product B yealds product C. So since you and I agree that diferent reactions happen from person to person with drugs, you might also see how unscientific the medical comunity really is. Medicine is the practice of trial and error and cover up not science.

ALSO

Studies are there supporting my calims, Chiropractic has hundreds of thousands of case studies, thousands of peer reviewed studies and hundresd of medical (M.D.) peer reviewed studies. All which support our guidlines and philosophies. If you would like a list of referances all you need to do is ask.

Eric McKillican D.C.

Dr. McKillican

I believe you are confusing “Science” and “Scientific method”. They are not the same. Medical Science relies on clinical evidence to arrive at conclusions and therapeutic recommendations. The strength of these recommendations is determined by the strength of the methodology of data acquisition and analysis. Observational series (Case studies) represent the weakest method of data procurement and are merely anecdotal. Randomized prospective controlled studies are the strongest method and infer definite clinical benefit.

Please site a single “prospective randomized controlled trial” (or meta-analysis), where the “confidence interval” exceeds minimal clinical benefit, supporting the effectiveness of manipulative therapy in the treatment of anything.

Thank you,
Gerald M. O’Brien, MD
(Clin.) Associate Professor of Medicine
Temple University School of Medicine

Enfield
1st August 2000, 20:01
Originally posted by Eric McKillican
You think medicine is science! Go back to basic chemistry and you will find science. Science is about 100%reproducable results every time. i.e. measured amount of product A + Measured amount of product B yealds product C. So since you and I agree that diferent reactions happen from person to person with drugs, you might also see how unscientific the medical comunity really is.

"100% reproducable?" I'll let my advisor know that, so that I don't have to write the "Error Analysis" appendix for my thesis.

1st August 2000, 20:27
Ditto what Dr. O'Brien said.

You can't argue with chiropractors. If they were to view objective data in a rational manner, they wouldn't be chiropractors. I'm not against holistic methods, either, but I prefer treatment with some objective evidence of results. It's a matter of odds, of course. I prefer to rely on something that has been proven to be 90 percent effective rather on some mumbo-jumbo with only anecdotal evidence of success. It only makes sense.

"Studies are there supporting my calims [sic], Chiropractic has hundreds of thousands of case studies, thousands of peer reviewed studies and hundresd [sic] of medical (M.D.) peer reviewed studies. All which support our guidlines [sic] and philosophies. If you would like a list of referances [sic] all you need to do is ask."

Since you brought it up, I would like to see this evidence to support your claims.

Dr. Chad
2nd August 2000, 20:56
This argument is now over 100 years old. Every time a chiropractor

states that his or her patients are responding to adjustments and

experiencing a higher level of health and well-being, the medical world

dismisses it as anecdotal and "mumbo jumbo" and want to see double blind

controlled studies. Individual chiropractors do not have the funding to

fund such studies and no giant drug companies to provide the money.

So...all we usually have is our 100 years of experience to show that it

works and our satisfied patients that refer their families and loved

ones. When I adjust a four month old infant for injuries caused by a

traumatic birth and see dramatic improvements in that childs health, I

don't need to read it in a peer reviewed journal that what I did is TRUE

. The parents don't need any more proof than that either. That is why I

see families and my practice is families from new babies to great

grandparents. They all come in together and if subluxated, recieve their

CHIROPRACTIC spinal adjusments that they know interfere with their nerve

systems therefore decreaseing their level of health. This confidence

factor as well as placebo effect I feel is not significant when I adjust

a baby. I don't tell them "This is going to stop your colick and

fevers.", but they still respond...just like everyone does. I've seen

studies that show a sham operation (one where only scars were made)

actually showed a better result for meniscal tears found on MRI than the

actual knee surgery that was performed. Which has a stronger influence,

the surgry or the placebo? According to this study, you'll fair er

influence the surgery or the placebo. According to this study, you'll

fair better if you have your doc make a few random cut around your knee.

If you want results you can come to my office and see better than 90%

but you must remember, that is anecdotal so you may want to talk to the

individual patients that have no more symptoms but still want their

spines checked for any residual or new subluxation so they can maintain

their newley achieved higher state of wellness. If you do find a 90%

effective rate in medicine it still usually will be much more invasive

than a chiropractic adjustment. ie.liver or renal toxicity and side

effects...but yet this is the "GOOD SCIENCE"that some think is the u

ltimate in health care today. I agree that we need research in order for

the allopathic world to accept what we say but I also am sometimes

suspicious of research, the stats provided and who funded the studies.

The research told us that we should give all our children the wonderful

new rotavirus to keep them healthy, (a recommendation that M.D.s held

stead fast to), and now we see that the risks greatly outweigh the

risks...but "GOOD SCIENCE" told us first that it was OK. Medicine use to

say to circumcise, now they say there is no benefit. Prozac is good for

depresion, now it can cause suicidal tendencies. The list goes on and on

and keeps getting longer and longer. These ideas were at one time

supported by "GOOD SCIENCE." Where were the real experiments being

performed?...I feel it wasn't in the labs. In most of these cases it's

the "anecdotal" evidence that gets bad medicine off the shelves and get

erroneous procedures stopped. I don't know what chiropractic MEDICINE is

but it does sound dangerous since it is not being perfomed by a doctor

of chiropractic...as for chiropractic spinal adjustments and

chiropractors, I have not seen this evidence that it is dangerous but

would be interested in it and by what means it was attained. As for what

I've seen, I would put a CHIROPRACTORS record up against that of any

practitioner of "GOOD MEDICINE". I would even check it against the Mayo

clinic where in one study showed after autopsy that 70% of teh original

diagnosis was wrong...GOOD SCIENCE?!? As long as medicine remains the

allopathic entity that it is it will never be able to understand the

vitalistic view that the world is crying for. We will try to show you

the way but as long as you want GOOD SCIENCE, our ideas will fall on

deaf ears. THANK YOU

MJHildreth
3rd August 2000, 00:42
Originally posted by budokai
I don't disagree with holistic health approaches. I think there are a lot of benefits to this. However, medical science is just that, a science. It involves experimentation, and unfortunately, there is no one reaction for every treatment in different individuals. Some respond, yet there will always be some small minority which don't.

As for the quackwatch site, it appears to be very well documented and objective. The cult-like posturing of chiropractors aside, there is a lot of evidence that chiropractic medicine is dangerous in many hands. Despite your negative feelings toward the AMA, I would trust the members of that organization over chiropractors any day. Personally, I prefer the scientific approach to health over the mystic.


I agree with Dr. O’Brien, that Dr. McKillican is confusing science and the scientific method. I'll agree that until the 1980's there was very little quality research done on the efficacy manipulative therapy, however, that has changed.

Here are some studies and a textbook or two for you to investigate:
Hadler, NM, Curtis P, et al. A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial. Spine 1987;12:703-6

Meade, TW, Dyer, S et al. Low-back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. Br Med J 1990;300:1431-7

Meade, TW, Dyer, S et al. Randomized comparison of chiropractic and hospital outpatient management for low-back pain: results from extended follow up . Br Med J 1995;311:349-51

Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low-back pain. Can Fam Phys 1985;31:535-40

Bronfort, G. Efficacy of manual therapies of the spine.
Amsterdam: Vrije Universiteit EMGO Institute, 1997

Lewit K. Manipulative therapy in the rehabilitation of the locomotor system, 3rd. ed. Oxford, England:Butterworth Heinemann, 1999. Chapter 10.

Jerry O'Brien
3rd August 2000, 03:05
Originally posted by Matt Hildreth
I'll agree that until the 1980's there was very little quality research done on the efficacy manipulative therapy, however, that has changed.

Here are some studies and a textbook or two for you to investigate:

Thank you Mr Hildreth for your comments and the references. I am not against chiropractic or alternative/complementary medicine, but I am against ignorance. Science is about finding the truth through the systematic analysis of data. If the data support effectiveness good…if not, then the therapy is experimental or unproven, simple as that. A lot of what I do is just that and I am honest and upfront about it with the patient. I make it my business to know the data, because every now and then a patient will have done their own homework.

I did my own literature search on the effect of Spinal Manipulative Therapy (SMT) and was surprised to find a number of RCT’s. Most of the trials have few subjects and often the end points are poorly defined. Unfortunately these flaws detract form the strength of the studies and their conclusions are widely disparate. Below is an abstract from a meta-analysis recently published which best summarizes the data currently available.

[SEE BELOW}

While there is a dearth of data regarding the effectiveness of SMT for the treatment of low back pain, there is at least level II Grade B evidence of benefit. Moreover, SMT appears to be very safe. Obviously, a large multi-center RCT would answer the question and is needed.

Finally, I have four questions for Dr. Chad. 1) What is your full name? 2) What have you published? 2) Do you read your own literature? 3) Could it be that the real reason for the lack of quality clinical research of SMT be due to a fear of a negative result? I mean it would seem to me that the pooled resources of Chiropractic Schools would be sufficient to support such a project.

Respectfully,
Gerald M. O’Brien, MD

Jerry O'Brien
3rd August 2000, 03:08
The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling.

Assendelft WJ - J Manipulative Physiol Ther - 1996 Oct; 19(8): 499-507

From NIH/NLM MEDLINE, HealthSTAR
NLM Citation ID:
97058340

Full Source Title:
Journal of Manipulative and Physiological Therapeutics

Publication Type:
Journal Article; Meta-Analysis

Language:
English

Author Affiliation:
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.

Authors:
Assendelft WJ; Koes BW; van der Heijden GJ; Bouter LM
Abstract:

OBJECTIVE: To determine the effectiveness of chiropractic treatment for patients with low back pain by means of a systematic review of the literature. DATA SOURCES: Randomized clinical trials (RCTs) on chiropractic were identified with a Medline and Embase search (1966-1995), by citation tracking, and by hand searching of the relevant chiropractic reference systems (CRAC and Index to Chiropractic Literature). STUDY SELECTION: All RCTs on low back pain that involved chiropractors as therapists. DATA EXTRACTION: Methodological quality was assessed independently by two reviewers on 14 items covering internal validity, informativeness and study size. Data were extracted on: patients (initial referral, duration of complaints, radiation of pain); outcomes (four different types); and timing of follow-up (short-term, intermediate and long-term). Statistical pooling was intended, according to a preset analysis plan, to include subgroup analysis. DATA SYNTHESIS: Eight RCTs were identified. All RCTs had serious flaws in their design, execution and reporting. Because of the great variety of outcome measures and follow-up timing, there was insufficient data to enable statistical pooling of the RCTs. A narrative review, however, did not provide convincing evidence for the effectiveness of chiropractic for acute or chronic low back pain. CONCLUSIONS: There is certainly a need for correctly executed trials. In future research on the effectiveness of chiropractic, guidelines for uniform execution and reporting of RCTs should first be established to enable subsequent statistical pooling in systematic reviews of chiropractic trials.

Eric McKillican
3rd August 2000, 04:09
This is turning into a debate over what the finite differences are in science, that was not my intention at all. And I agree with the previous doctors comments. I was responding to a members request when another member (budokai) made an out right, bold, misleading statement about chiropractic being quackery, mystic, cult-like, and unscientific. He would much rather rely on his scientifically proven medical methods. I do not have a problem with science or its methods. I utilize and rely on scientific studies and research everyday in my practice. I don't have a problem with medicine, I recognize it's strengths and weaknesses. I don't even care what budokai chooses to use as his primary method of health care. I do care when someone¹s opinions expressed are, false... misleading, and biased regarding a profession he knows little to nothing about.

To compare medicine to chiropractic is like comparing a plumber to an electrician. They both may work on the same house, however their functions are totally different and distinct. One would be called to react to clean pipes that would be backing up or fix leaks due to years of wear and tear, while the other would ensure that every outlet and appliance in the house is getting the appropriate electricity to ensure proper function throughout the house. One is reactionary the other is proactive. Both professions are needed they just have different duties. To expect one to perform as the other is utter nonsense.

Chiropractic is not a substitute for medicine, therefor I choose not to debate what medicine is or is not. Chiropractic on the other hand is not for the treatment of any disorder, illness or condition. It is the detection and correction of interference to the communication system of the body. Chiropractic works so well because it is non intrusive and respects the bodies own healing potential. Low back results just happen to be the tip of the ice burg.

For more Info and resurch try the International Chiropractic Association's web page or the Journal of Vertebral Subluxation Research, http://www.jvsr.com, for starters.

Eric McKillican D.C.

3rd August 2000, 04:34
"I was responding to a members request when another member (budokai) made an out right, bold, misleading statement about chiropractic being quackery, mystic, cult-like, and unscientific. He would much rather rely on his scientifically proven medical methods."

Eric,

Even I can go and read your first post which started this thread. You were slamming quackwatch.com as being unscientific and anti-chiropractic treatment. Let him who has no opinion be the first to cast the bold statement. Somehow you've turned this thread all around in your last post.

I still think chiropractic medicine is mostly anecdotal. In most cases, I suspect the placebo effect is the primary cause for patient improvement. Who is to say that the baby didn't respond to other treatment or just plain grow out of the colic instead of the SMT? There is no way to say the next patient may or may not respond to SMT or even what the chances are the treatment will work. Furthermore, the manipulation of the spine can be dangerous. There are numerous documented cases of injuries caused by improper SMT.

I may not be a doctor, but I was a hospital corpsman in the U.S. Navy. I have seen amazing things such as "OK anesthetic" which is 100 percent mental. (Instead of giving the patient another injection of painkiller, you say "Okay, we're almost done" or you tell them you gave another injection, but not really, yet they stop feeling pain. This was done when another injection might be detrimental.) However, I would never rely on the placebo effect to actually TREAT a person's disease or injury. It might be fine for some symptoms, but it just doesn't cut it when it comes to resolving the root problem, unless the problem is entirely a subconcious reaction.

I'm sorry, but I still prefer to go with the tested, tried, and true, rather than some mysterious spinal adjustment and a vague story about someone's aunt who "felt much better" after SMT.

MJHildreth
3rd August 2000, 12:57
Don,
The RAND report in 1996 included a review of the comparative risk rate for cervical manipulation and some medical treatments and reported the following rates of serious complications:
- Cervical manipulation: 1.5 per million treatments (eg., stoke from damage to vertebral artery and neurological complications.

- Over the counter non-steroidal anti-inflammatory drugs (NSAIDs): 1,000 per million patients, and 3,200 per million patients age 65 and above (eg., serious gastrointestinal perforation or bleeding causing hospitalization and, for 10-20% of those patients, death).

- Cervical spine surgery: 15,600 per million surgeries (eg., paralysis or stroke).

Mortality rates are estimated at )0.27 per million for cervical manipulation (i.e., 1 in every 3-4 million tratments) but 6,900 per million for cervical spine surgery.


Dr. O'Brien,
The Meade study consisted of 741 patients at 11 clinics throughout the UK, was a randomized, controlled
trial by medical researchers funded by the British Medcial Research Council and was to compare standard chiropractic and medical/physiotherapy (hospital outpatient back clinics) treatment for patients with low-back pain of mechanical origin.

This trial is probably the most influential because of the size, scientific design, independence, and results.

Hope this helps,

Matthew Hildreth, D.C.

3rd August 2000, 14:14
Hitting my head against the wall may not always cause serious injury, but why risk it when it doesn't do any good, either.

Kent,

I agree with you about holistic medicine. I lived in Singapore and have personally witnessed some pretty amazing things using traditional Chinese medicine. Most of it includes diet, exercise, and herbal-based medications. Modern medicine is also learning much from traditional treatments. However, spinal manipulation has never been shown to have consistent positive effects. I think SMT is mostly placebo effect, but it also introduces a risk of serious and even permanent damage.

Let's say I set up a clinic and start treating everything with foot massage theraphy. Now foot massage theraphy may not have any negative effects, in fact, it feels pretty good. Over time, I am sure to have "patients" who have symptoms reduced or even eliminated following my treatments. This is just the law of averages; some people get better without treatment over time. However, now I can claim that foot massage theraphy is "proven to be effective." Further, I can assert that foot massage theraphy is even safer than drugs or surgery because studies have shown these are only effective in 90 percent of cases and even have a small percentage of further complications.

The bottom line is still that foot massage has little or nothing to do with the result. Would you want to be treated for cancer with foot massage? Many people buy into this kind of anecdotal evidence and will pursue foot massage instead of seeking proper treatment. This is the danger inherent in this kind of argument.

[Edited by budokai on 08-03-2000 at 08:25 AM]

Eric McKillican
3rd August 2000, 14:42
Don,
You must be so busy posting flaming threads that you are forgetting what you posted only a few days ago. If you go back to the Knee and Back problems thread you will find your first response regarding Chiropractic, where you introduced the quackwatch issue. This thread began by mistake only. I am new to this forum and pushed the New messages button instead of the post reply one.

In response to the allegation that the chiropractic adjustment causes joint damage and is dangerous. Well I refer you to the malpractice rates of a chiropractor, my rates for maximum coverage for one year is less the $1100.00. Since the insurance companies adjust the rates from profession to profession and base those rates on the risk for liability, ones rates can reflect ones dangers to the community.

OK, when a spinal joint is injured or sprained. A reactionary process happens. The joint swells and becomes immobilized, nerves are pinched or irritated, muscles react and either weaken or spasm, over time the swelling and immobility result in fibrous adhesions (scar tissue), if a joint is left in this state, over time a degenerative process begins and continually degenerates the joint and surrounding tissues. The adjustment is designed to restore normal motion to the injured joint thus stopping this reactionary process. Yes stretching and exercise help to maintain good spinal motion and I encourage it. However when one joint becomes immobilized the other joints make up for the loss of motion and creates a hypermobility throughout the spine, at the same time the injured joint is continually being injured and the reactionary process continually gets worse. The adjustment must be specific to the injured joint and not to the surrounding ones for it to be corrective. When one makes gross forceful manipulations to the spine trying to hear a pop, that is when damage occurs to healthy joints. Hence, why chiropractors perfer to use the word adjustment over manipulations.

By the way the adjustment of spinal vertebrae does not have to make a popping sound. There are several techniques that rely on low force no sound adjusting.

With regards to placebo, I have heard this story. A boy who suffers from asthma has exhausted and tried every medical treatment out there, when his father takes him to a chiropractor. After a coarse of care the boys asthma improves so much that he no longer needs his daily preventative inhalers. The father goes to the MD and asks him why did you not tell me that chiropractic worked so well for asthma? The doctor replied, chiropractic doesn't work, it is just a placebo. The father replies, why didn't you tell us that chiropractic was such a good placebo. The point of this story is that we can't forget what is good for the people who intrusted their care to us, placebo or not. And if chiropractic was so dangerous and damaging then why have people made chiropractic the largest non-medical health care profession today.

I also utilize several other natural approaches to my health care. I have a massage once a week, I go to yoga classes regularly, I eat healthy whole foods, I exercise daily, I allow my body to sleep and regenerate, I keep a positive attitude and I get my spine adjusted regularly to ensure a properly functioning body. As a result of living this way my entire life, I have never had any major illness, I have never been on over the counter or prescriptive meds, nor have I had any surgery for any condition. The interesting thing is both my brothers share this same story, the same is true for all of our children. Placebo or not we are living healthy and not waiting for problems to arise. You do realize that symptoms usually appear once the condition has advanced so much that permanent injury has occurred. That is two late for me. I choose to maintain my health before I ever need to react to any condition.

Eric McKilican D.C.

Jerry O'Brien
4th August 2000, 16:18
Originally posted by Matt Hildreth

Dr. O'Brien,
The Meade study consisted of 741 patients at 11 clinics throughout the UK, was a randomized, controlled
trial by medical researchers funded by the British Medcial Research Council and was to compare standard chiropractic and medical/physiotherapy (hospital outpatient back clinics) treatment for patients with low-back pain of mechanical origin.

This trial is probably the most influential because of the size, scientific design, independence, and results.

Hope this helps,

Matthew Hildreth, D.C.

Thank you Dr Hildreth.

Meade et al. report a 29% improvement in low back pain among patients treated with SMT compared to those treated by hospital physiotherapists.

[see below}

Their conclusions sound impressive but the abstract provides little information, so I had to pull the paper and look at their methods the data.

The study is good in that they were able to study a large number of subjects and report data out to 36 months after enrolment. The endpoint of the study were improvements in subjective measures of disability obtained by via a questioner which used a point scale of 0 to 100. (the higher value, the fewer the symptoms). The scores were compared using chi-squared analysis and unpaired t-test.

However, this study has a number of flaws in both the methodology and analysis that detract significantly from the strength of their conclusions.

First, I have a problem with the patient selection and randomization. While there was no significant difference in the baseline disability score between groups, patients initially presenting to a chiropractor were self selected on the basis that they believed that chiropractic would be effective. Moreover the patient follow-up rate for the control group was only 70%, significantly less than the treatment group, which can introduce significant statistical bias.

The researchers also failed to standardize the quality and methods of therapy in the control group. I mean, standard hospital physiotherapy can mean a lot of things, and quality IS an issue. It also appears that the SMT group received a not only more therapy sessions but also over a longer period of time.

Finally, the authors report a 29% improvement (mean improvements of 14 vs 11 points) in the Oswesrty score at 6 months (p<0.02). In fact only a 2 to 4 percentage-point advantage of chiropractic SMT over hospital outpatient management was reported at 1, 2, and 3 years(1 point?). On a scale of zero to 100, what does a 1 or 3-point difference really mean in clinical terms?

While this study is provoking and supports the benefit of SMT, a more rigorous trial is needed as was suggested by the authors themselves.

Regards,
Gerald M. O’Brien, MD







[Edited by Jerry O'Brien on 08-04-2000 at 10:27 AM]

Jerry O'Brien
4th August 2000, 16:20
Meade TW - BMJ - 1995 Aug 5; 311(7001): 349-51
From NIH/NLM MEDLINE, HealthSTAR
NLM Citation ID:
95367884

Comment:
BMJ 1995 Nov 11;311(7015):1301-2
BMJ 1995 Nov 11;311(7015):1302

Full Source Title:
BMJ

Publication Type:
Clinical Trial; Journal Article; Randomized Controlled Trial

Language:
English

Author Affiliation:
Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, Medical College, St Bartholomew's Hospital, London.

Authors:
Meade TW; Dyer S; Browne W; Frank AO

Abstract:
OBJECTIVE--To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain. DESIGN--Randomised allocation of patients to chiropractic or hospital outpatient management. SETTING--Chiropractic clinics and hospital outpatient departments within reasonable travelling distance of each other in 11 centres. SUBJECTS--741 men and women aged 18-64 years with low back pain in whom manipulation was not contraindicated. OUTCOME MEASURES--Change in total Oswestry questionnaire score and in score for pain and patient satisfaction with allocated treatment. RESULTS--According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear. Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment. Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management. CONCLUSIONS--At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals

Dr. Chad
4th August 2000, 21:25
What is Chiropractic?



When a sperm fertilized an ovum and you became you, a

genetic blueprint

was created that determined the color of your eyes and

millions of other

details about you.



To control and organize your growth, the nervous

system consisting of

your brain, spinal cord, and all the nerves of your

body were the first

tissues formed.



Today your nervous system controls the function of

every cell, tissue,

organ and system of your body.



The skull protects your brain. The vital communication

pathway of

the spinal cord is vulnerable, covered by 24 moving

bones of the spinal

column. Pairs of nerve roots branch off the spinal

cord between each spinal joint to service the organs

and tissues of your body.



Because of the way your spine was designed, improper

motion or position

of spinal bones can irritate or choke delicate nerves

-- interfering with

the function of the tissues they control. Doctors call

this a subluxation.

Trauma, which may occur to the spine from the birth

process, is often the

first source of nervous system interference.



Car accidents, stress, poor diet, long periods of

sitting, and many other

everyday activities can cause the bones that cover you

spinal cord to

lose their normal position and motion.



Without a normal nerve supply, affected organs and

tissues are more

susceptible to disease, often producing the symptoms

of pain and ill

health.



Headache and low back pain can often be traced back to

spinal malfunction

and nervous system interference.





Doctors of Chiropractic are specialists in the

detection, reduction, and

prevention of nervous system interference.



Today chiropractors require four years of

undergraduate study plus four

years of chiropractic school. Before starting practice

they must pass National and State Board Examinations.



To determine the cause of your health problem,

chiropractic doctors

examine your spine to locate any areas causing nervous

system interference. You'll be shown the exact

locations of any nervous system interference and get

specific recommendations for your chiropractic care

program. Your doctor will use carefully directed and

controlled pressure to return malfunctioning spinal

bones to their proper motion and position, reducing

nerve interference. This procedure is called a

chiropractic adjustment.



There are many ways to adjust the spine. Adjustments

feel good. Millions of chiropractic adjustments are

safely delivered every day.



In fact, chiropractic adjustments are safer than back

surgery, muscle

relaxers and even aspirin! So safe, even newborns can

receive

chiropractic adjustments.





Regardless of the type of doctor you consult,

doctors don't heal. Only your body can heal itself.



The chiropractic approach to better health is to

remove the interference to your own inborn healing

ability. Chiropractic makes sense. It¹s provided by

well-educated doctors. It¹s safe. It¹s natural. It

looks to correct the underlying cause(s) of your

problem.

And most of all -- it works.

Enfield
4th August 2000, 21:55
Note: bad formatting removed

Originally posted by Dr. Chad
... improper motion or position of spinal bones can irritate or choke delicate nerves -- interfering with the function of the tissues they control. Doctors call this a subluxation.
Doctors call a partial dislocation a subluxation. It doesn't have to do with impairment of the nervous system, though it could.

Without a normal nerve supply, affected organs and tissues are more susceptible to disease, often producing the symptoms of pain and ill health.
I wasn't aware that nerves were something had to be supplied to organs and tissues. I thought they were either there or not. What system is it that supplies nerves to organs?

Today chiropractors require four years of undergraduate study plus four years of chiropractic school. Before starting practice they must pass National and State Board Examinations.
It takes a long time to get a Ph.D. in sociology as well, but I'm not going to someone who has one to help me get over pneumonia.

There are many ways to adjust the spine. Adjustments feel good. Millions of chiropractic adjustments are safely delivered every day.
And this is somehow related to efficacy of treatment?

In fact, chiropractic adjustments are safer than back surgery, muscle relaxers and even aspirin! So safe, even newborns can receive chiropractic adjustments.
Sitting on a couch is safer than surgery or drugs as well. Even newborns can do it. But, again, how does this demonstrate effectiveness as a means to better health.

The chiropractic approach to better health is to remove the interference to your own inborn healing ability. Chiropractic makes sense. It¹s provided by well-educated doctors. It¹s safe. It¹s natural. It looks to correct the underlying cause(s) of your problem.
Well, what the chiropractor claims is the underlying cause. Safety and naturalness don't equate to efficacy or healthiness.

And most of all -- it works.
And the proof of this is . . . ?
While there is evidence that chiropractic is an effictive treatment for back pain, I'd like to see some credible evidence that it works for other ailments.

Jerry O'Brien
5th August 2000, 03:37
Dr Chad:

I agree that Chiropractic is safe but if you are suggesting that it is effective for conditions other than low back pain...please show us some Data.

Gerald M. O'Brien, MD