The Institute for Science in Medicine issues a warning about the hijacking of health care reform by pseudoscience and religion

I noticed one David Gorski, MD, PhD as the Treasurer. Hmmmm, now where have I heard that name before?

A finer group of skeptics could not have been assembled, including many of my heroes, the inimitable Mark Crislip of my beloved QuackCast podcasts.

Almost all the names jumped out at me, so I have to hope that, as a group, all these untiring skeptics will be able to accomplish great things as a group.

I generally don’t adhere to or support any particular -ISMs, but this is one ISM I can. 😛

Featuring not one but several of the energizer bunnies of skepticism in medicine no less!

Well, just because Medicare currently covers faith healing and other nonsense doesn’t mean that can’t change. The ISM will have their work cut out for them indeed, but it’s never too late to try, IMO.

Make link on that site for donations.

Idea for inspiring donations: invite people to flag their gifts to specific tasks, e.g., “Please comment on X book, bill, article, website, product…”

Create a web page listing requests in a table with a column showing funds donated for the task. Tasks with the most cash behind them at the top of the list.

Second idea: create a “thank you” page listing doners either by name or pseudonym. Send doners membership cards and a bumper sticker.

Third idea: sell swag such as coffee mugs, wrist bands, pins, t-shirts. Students often can’t afford to be openly critical of woo faculty. But they can wear a bit of swag to signal their feelings to like minded peers.

“Dr. Wonderful:”

You do realize the ISM Board really is not a very credible lot themselves, however? Jann Bellamy? You can’t be serious.

Coming from you, that’s high praise indeed — although you did forget to mention those like Drs. Novella and Gorski. How could you forget them?

Off to a good start! I’m looking forward to the endorsements from AoA, Mike Adams, etc.

DC Session- never heard of those two blokes. I’m sure they are just lovely people.

The list does, however, read like a “Who’s Who” of known chiro-hunters who lack any credibility. Why do they lack credibility? Because they refuse to acknowledge evidence that proves them wrong when it is presented to them. The evidence for the efficacy of chiropractic treatment of musculoskeletal conditions is substantial. It’s the saeme xact stuff PT’s, some orthos, some PMR guys, and Osteopaths do. It’s basic physical medicine but yet, according to these clowns, it is fraudulent only when a chiro does it? Blah, blah, blah.

By the way…has this group even read the bills or are they just cherry picking sections out that can be miscontrued to fit their pre-detrmined agenda and give their ego’s the platformt hey desire? It states very clearly in the bill that coverage is mandated for procedures that have “A” or “B” level of evidence (hah! most chiro procedures!) and in certain cases “C” evidence will be covered. Do you think faith healing will meet that threshold?

Joey- Not sure what your link is all about but again demonstrates you cannot have an objective discussion on this subject. You’re really just a bit of an asshole, aren’t you/ Do you see me putting shit like that up? BUt yet you are more ceredibly than I am?

I think a more appropriate question is why do Bellamy, Barrett, Ernst et al think cervical manipulation is only unsafe and ineffective when performed by a chiropractor? Yet it is valid, safe, and effective when performed by a physical therapist, orthopedist or osteopath. Does that sound like a credible position? One that is based on evidence? Or does it sound like a discriminatory attack on chiropractors that perform the same procedures as many other provider groups? Who’s the quack?

I think it’s great to see all these wackos connected.

@DrW:
“I think a more appropriate question is why do Bellamy, Barrett, Ernst et al think cervical manipulation is only unsafe and ineffective when performed by a chiropractor? Yet it is valid, safe, and effective when performed by a physical therapist, orthopedist or osteopath. Does that sound like a credible position? One that is based on evidence? Or does it sound like a discriminatory attack on chiropractors that perform the same procedures as many other provider groups? Who’s the quack?”

Generally when it’s done in an acute care setting, it’s done because of a legitimate surgical reason to manipulte the position of the vertebral column (Vertebral dislocation, etc), and is confirmed by CT/MRI scan and done under careful, controlled conditions.

Most chiropractors I know don’t even have an X-Ray scanner, let alone a CT or constant fluroscopy.

TN Paramedic- actually you’re not correct. The need for manipulation is not to be determined by x-ray. X-ray is not a screening tool, it is a diagnostic tool. It is used in a chiropractors office to differetnially diagnose a scondition when inidcated, exactly like it would be in an ortho’s office. X-ray does not to determine the appropriateness of of a particular manual procedure.

Also, you are incorrect when you say a chiropractors only performs manipulation to correct a subluxation. We estimte less than 10% adhere to that way of practice, or nomenclature, and it is shrinking every year. Even still it is a musculoskeletal lesion they are finding and treating. Indictions for manipulation are pain, loss of symmetrical movement, inflammation, muscle spasm, loss of normal daily functions, etc. The same exact indications as when a PT, ortho, osteopath or PMR does it.

It very rarely is done in an acute setting such as what you describe and for completely different reasons. Although, as a paramedic it may be what you are primarily exposed to. It’s actually a completely different type of manipulation.

TN Paramedic- my apologies. You did not try to tie all chiro’s the the subluxation nomenclature as I indicated. I was thinking of someone else.

-Also, you are incorrect when you say a chiropractors only performs manipulation to correct a subluxation-

then are you really still a chiropractor? Instead of just a specialist sports therapist.

The chiro hunters have three problems with chiro.
The fact that it often goes hand in hand with other woo, the fact that it was originally based on subluxations and the fact that people are going for unnecessary and dangerous mutliple neck manipulations from some chiro’s.

It may be a few bad chiros mixing in woo and performing what amounts to last century medicine but it is this which the chiro-hunters are annoyed about. As well they should be.

Omigod, I got censored! Somebody else got through with a similar comment. Really, this is childish. Let me just say that I am impressed with the names of the Board of Directors for the new group. I, too, would like to see a “donate” button at the site. The group will have to raise a lot of money if it is to make a start on this mess.

To the angry chiro: Hey, you forgot to mention a big difference between chiros and others using these techniques: THEY went to medical, PT, etc. school–you did not.

It seems to me that the root problem is that the states ever started licensing anyone who has not been to medical/nursing/physical therapy school to treat people. Only those with science-based training should be laying their hands on people.

Anthor- your ignorance is showing. Chiropractic schools are an additional 5 years after undergrad and include all levels of differential diagnostic course work. A patient is much safer and treated at a higher level of competency than with any physcal therapist. We are licensed physicians.

Richard- yes, I am still a chiropractor even if I do not use the subluxation nomenclature. The term, by the way, has been draining out of the profession for the last 20 years. We’ve also been reducing the unfounded “claims” chiro’s make in their advertising and when discussing treatment with patients as we also move toward evidenced based patient center care. The schools, state associations and major national association have taken the lead.

We estimate approximately 10% of the chiro’s practicing today still use the subluxation terminology and adhere to the yet to be proven belief that spinal misalignment can lead to more than a musculoskeletal compaint.

Now, mind you the findings of a “subluxation” as some chiro’s still call it still represents a musculoskeletal lesion…pain, inflammation, asymmetrical movement, loss of ability to perform normal daily activites, etc. Just an old school term that has been updated by various professions, including ours, over the past century.

The question is…can a structural distortion cause poor health in addition to poor function? The answer is yes, and this is generally accepted by everyone who treats the human frame. Except maybe an ortho surgeon who really has only 1-2 encounters per diagnosis and may not see or hear this type of testimony because they are so focused on parts and procedures (Thank God too, because we need that). They should not discredit, however, what those of whom have 12-18 encounters per diagnosis might experience over that extended period of exposure.

The problem is the possible mechanism by which health might be improved is certainly not defined or worked up by science. Most of us understand that and like you say do not practice in what we call the “chiro stone age.” Most evidence that health improves as musculoskeletal conditions are corrected is purely based on patient testimony over the course of a hundred plus years. There are siome preliminary studies in certain cases but nothing conclusive or overarching. You’ll find, however, that PT and Osteopathic patients reporting the same thing. This certainly is not valid science but also cannot altogether be dismissed especialyl as moreand more typeso providers are reporting the same types of htings now that they employ the same type of spinal manipulative therapy. PT and Osteopaths are mroe responsbile in their reporting and advertising, true.

I hope this helps. I would ask that when discussing the chiropractic profession that we no longer only equate the name of the provider with the procedure being discussed. Multiple provider groups are doing the exact same procedures.

Boy you’re a real genius Ms. Hall. Thank you for repeating what I have been saying for the last few weeks and, of course, taking credit yourself. You chiro hunters are something else. Thanks for trying to tackle an issue we already tackled 20 years ago! And why do you refer to the evidence of efficacy as “limited”? I guess that’s your own personal bias coming through? Along with everyone else, I’d say it’s substantial.

I do take exception with your conclusion that cervical manipulation has been tied directly by science to the incidence of VAD. You do realize the one study you guys constantly roll out has already been debunked and oh, by the way, in that study the vast majority of the post manipulation injuries were performed by PT’s and MD’s!!! What was it? Oh yeah..chiropractors performed 80% of the manipulation in the study and caused 4% of the injuires while PT’s and MD’s performed 20% of the manipulation and caused 96% of the injuries!!!! You never seem to disclose that one little fact, however. The study concludes manipulation is perfomed safely when done by a chiropractic physician!!! Yet you seem to twist it the other way? Talk about a lack credibility!

Just to illustrate, I Googled for chiropractors in the Boston area, where I live. Here’s a rundown of the top hits (skipping duplicates):

1. Offers acupuncture. Site has a detailed explanation of subluxations.

2. Claims to be able to treat allergies, mood swings, digestive disorders, among other things. Again explicitly explains subluxations as the cause of all ills.

3. Cannot be evaluated, no meaningful web page.

4. Again embraces subluxations. Actually does not appear to offer services other than manipulation.

5. Yep, subluxations again. Claims to treat ADHD, allergies, asthma, bedwetting, and PMS among other things.

6. 404 error.

7. Not a chiropractor.

8. More subluxations. Offers acupuncture. Sells various recommended products on their website – note that this would be considered grossly unethical by real doctors!

9. Also says that subluxations are what chiropractic is all about. Offers to treat headache.

10. More acupuncture, no information regarding subluxations.

11. Subluxations again. Claims to treat headache and concussion.

12. More subluxations, offers to treat fibromyalgia.

13. Acupuncture, “holistic” medicine including what sounds like reiki. Subluxations.

So of the top 10 sites which offered any actual information, nine explicitly endorsed subluxations. None rejected them. Similarly, nine offered completely invalid treatments and/or treatments for conditions for which chiropractic has no demonstrated applicability. None of the 10 passed both tests.

So tell us again about how few chiropractors embrace this garbage?

Scott- The skeptic would say “small sample” (hah!) but still the fact that some chiropractors use acupunture is not a shock to anyone. It does work. Why? How? when? I have no clue. I understand why you’re skeptical. I do not use it in practice but have had it done to me 2 times. I was amazed it worked for a acutely sprained arch in my foot and wrist pain after playing tennis. Both times I was unresponsive over many weeks to chiro, PT, anti-inflammatories and one injection in the wrist. Each time one acupunture treatment knocked it out. I hear it a lot form patients of mine who ask to try something else if they are not reaching their goals with me. Again. I understand the skeptical view. Btw, some lasting effects of concussion are treated through all sorts of neuro rehab techniques that both PT’s and Chiro’s do regularly…not only manipulation.

Regarding the subluxation, you may be seeing the term being used interchangeably with musculoskeletal complaints, here. I have no idea what you are really reading.

However, you may be suprised to learn that chiro’s do treat many ailments naturally but not neccesarily through spinal manipulation or even by attributing the conditions to subluxations. Can cholesterol be lowered without manip or meds? Yes. Can allergies, at least symptomatically, be affected without manip or meds? Yes. Can chronic asthma (not an acute attack) be affected without manip or meds? Yes. Can headaches be treated effectively with manip, meds or without either?…absolutely! In many cases very effectively. There’s even quite a bit of evidence about manip and heachaches. You’d be suprised how neuros refer to chiros for headache treatment. Increases every year. Do I understand why you are skeptical? Yes, I do. Do I agree you should have drawn such strict and definitive conclusions yet? Nope.

But you’d be shocked how much of what we do is evidenced based. Will you find it by searching for example “cholesterol and chiropractic”? No. How about looking at diet, natural lifestyle modifications, Omega-3, Niacin, Green Tea extract, Vit D, smoking cessation, exercise parameters, behavioral modifications…. It’s not all subluxation and manipulation in our offices. Some offices are that straight…maybe 10%. The rest are looking at all natural health care options for patients.

Listen, not all of these offices you cite are automatically tied to the subluxation as the cause or manipulation as the cure. They are not writing their advertisement for you, or even me. They are writing them for the general public and could a better job. I’ll bet you they are doing a much better jobin their offices than you assume. .

So, of your small sample size maybe 20% actually tie subluxation to to cause of disease and manipulaiton as the only cure. Not good enough but nearly as bad y’all make it sound. You cited 13 websites. There are 1900 chiros in Mass. Would you call your study well designed?

I think one of the problems is that all you know about chiropractic is the term subluxation and the procedure of manipulation so you put everything through that 2 dimensional prism. There’s more. A lot more. Sorry, but you’re knowledge here is very narrow.

Foregetting th very broad array of musculoskeletal protcols we employ we’ll take one easy exmple for both of us to digest…do you think I can help a person with Type II Diabetes? The answer is no if all you know about me is your pre-assumed and uneducated conclusion of “chiropractic only equals subluxation removal via manipulation.”

However, the answer is “yes” if you understood I have a very high level of expertise in the natural and well evidenced management of diet, exercise and behavior modfication. You may not be familiar with all the evidence surrounding natural manageent of Type II diabetes but do not immediately discredit the fact that I might! Most of it is common knowledge at the physician level, isn’t it?

So, how can Type II diabetes be managed naturally even without manipulation as the primary procedure? Do you know? If so, why can I not do it? We’ve been doing it for 100 years. About 90 years longer than allopathy by the way. Then play the same game with cholesterol, chronic asthma, obesity, some heart disease….

From a press release on the American Chiropractic Associations web site – http://www.acatoday.org/press_css.cfm?CID=3247 – (emphasis added):

Studies are beginning to show that chiropractic can help children not only with typical back and neck pain complaints, but also with issues as varied as asthma, chronic ear infections, nursing difficulties, colic and bedwetting.

From this quote, and the context in which it appears, it would seem they are suggesting that manipulation, not counseling or other non-manipulation strategies, can treat the bolded conditions. These are the same kind of things that Simon Singh called out for not being supported by proper studies.

Perhaps, DrWonderful, you have some links to the studies the ACA mentions? The ACA didn’t include any.

Scott- The skeptic would say “small sample” (hah!)

True, which is why I presented it only as an example. I can’t help but notice, though, that it’s more data than I’ve seen you present.

but still the fact that some chiropractors use acupunture is not a shock to anyone. It does work.

The science says otherwise.

I do not use it in practice but have had it done to me 2 times. I was amazed it worked for a acutely sprained arch in my foot and wrist pain after playing tennis. Both times I was unresponsive over many weeks to chiro, PT, anti-inflammatories and one injection in the wrist. Each time one acupunture treatment knocked it out.

Now, see, if you understood science you’d recognize that this is meaningless.

Regarding the subluxation, you may be seeing the term being used interchangeably with musculoskeletal complaints, here. I have no idea what you are really reading.

All nine quite explicitly said that subluxations, defined as minute displacements of the vertebrae, are the cause of most/all illness.

However, you may be suprised to learn that chiro’s do treat many ailments naturally but not neccesarily through spinal manipulation or even by attributing the conditions to subluxations.

The claims were to treat those conditions via manipulation because they are caused by subluxations. Anyway, if not manipulation, what’s the point of having a chiropractor do it instead of someone who DOESN’T claim that their practice is based on magic?

You’d be suprised how neuros refer to chiros for headache treatment. Increases every year.

Argumentum ad populum.

Do I understand why you are skeptical? Yes, I do. Do I agree you should have drawn such strict and definitive conclusions yet? Nope.

What this argument fails to recognize is that offering such treatment is effectively drawing a strict and definitive conclusion that they are safe and effective. Without such evidence, it is grossly unethical to offer the treatment. Absence of evidence can ONLY serve as an argument AGAINST! THAT is the “strict and definitive” conclusion I draw in many of the referenced cases; that there is no evidence to support it.

But you’d be shocked how much of what we do is evidenced based. Will you find it by searching for example “cholesterol and chiropractic”? No. How about looking at diet, natural lifestyle modifications, Omega-3, Niacin, Green Tea extract, Vit D, smoking cessation, exercise parameters, behavioral modifications…. It’s not all subluxation and manipulation in our offices. Some offices are that straight…maybe 10%. The rest are looking at all natural health care options for patients.

If you want to make a claim of 10%, provide data. In all cases I looked at, the office provided manipulation and woo. May there be some evidence-based interventions there too? Sure. But that’s not the point. The point is that the offering of interventions not supported by proper evidence is a major problem, and when such seems so widespread it more than justifies indicting the entire profession.

Listen, not all of these offices you cite are automatically tied to the subluxation as the cause or manipulation as the cure. They are not writing their advertisement for you, or even me. They are writing them for the general public and could a better job. I’ll bet you they are doing a much better jobin their offices than you assume.

So you’re justifying it by claiming that they’re engaging in false advertising. I hope you’ll excuse me if I don’t find that a meaningful defense.

So, of your small sample size maybe 20% actually tie subluxation to to cause of disease and manipulaiton as the only cure.

100% either make such a tie, or offer even more discredited treatments. Again, “only 20% are at the least invalid end of the spectrum” is an indictment, not a defense.

Not good enough but nearly as bad y’all make it sound. You cited 13 websites. There are 1900 chiros in Mass. Would you call your study well designed?

I would call it well designed but without much power. I would also say it has more power than the evidence you’ve prevented to back your assertions.

I think one of the problems is that all you know about chiropractic is the term subluxation and the procedure of manipulation so you put everything through that 2 dimensional prism. There’s more. A lot more. Sorry, but you’re knowledge here is very narrow.

Again, you don’t quite get the point I’m making. Offering more treatments is NOT any better when those treatments have even less validity than manipulation! And offering actual evidence-based interventions is NOT an adequate defense to the charge of offering treatments that are either unsupported or actively discredited!

Foregetting th very broad array of musculoskeletal protcols we employ we’ll take one easy exmple for both of us to digest…do you think I can help a person with Type II Diabetes?

Let me phrase the question a bit differently, if I might. (For clarity, I’ll agree that the answer to your specific question is Yes.) Do I think that anything you do that’d different from what a real doctor does can help a person with type II diabetes? No. Do I think that being able to offer standard advice on diet and exercise is a meaningful consideration relative to the offering of unsupported, discredited, and/or dangerous interventions? No.

So, how can Type II diabetes be managed naturally even without manipulation as the primary procedure? Do you know? If so, why can I not do it? We’ve been doing it for 100 years. About 90 years longer than allopathy by the way. Then play the same game with cholesterol, chronic asthma, obesity, some heart disease….

Allopathy does not exist, first of all. And mainstream medicine has been offering the same diet and exercise recommendations for a hell of a lot longer than 10 years. And if you’d like to claim that chiropractors have been offering such recommendations longer than mainstream medicine, I’m going to have to demand evidence.

Todd- I am not a spokeperson for the ACA so I really cannot comment on their web site. I would say that some of our more extreme evidenced based purists (yes we have a range as does Medicine) might cringe. I know we can help those conditions but I do not have the research on hand. You’ll have to aks them yourself. When I treat those conditions, usually at the request of a parent or pediatrician, I always disclose that I do know knw the lit well in these areas and we’re going to try a course of therapy. I wish more chiros would do the same.

I, however, see no references to manipulation in your piece as being the primary treatment protocol. The term “chiropractic” represents a profession and not a procedure. All of the conditions listed there do have safe, effective, and evidenced based natural protocols associated with them. All chiropractors are licensed to do such things. Off the subject… my wife drank a bottle of dark beer every night when nursing. Her Ob told her to do that, not her chiropractor. It worked, I guess.

Ear infections have long been known to respond to nutritional therapies and environmental modifications and there is much anecdotal evidence, and some clinical evidence, associated with spinal manipulation to break up the chronicity. Same could be said for enuresis. Osteopaths attribute this to strucural distortions in the sacral plexus. Chiro’s are not alone! Acute ear infections, I feel, should be co-managed with a pediatrician. My son’s pediatrician told me he sends the bed wetters to a chiro in town that treats a lot of kids and is amazed by the results.

As far as Mr Singh is concerned I’m not too familiar with his situation. what little I know makes me believe he likely fell into the trap of commenting on “chiropractic” as if it represented just one procedure (manipulation) with just one goal (subluxation removal) instead of understanding we are physicians that specialize in natural health care with an obvious emphasis on structure. He commented on Chiro circa 1910 and had no idea we evolved so much beyond what he accused us of. His fault, not ours. I beleive nbut am not sure that he also grossly, horribly, over exagerated the risks associated with cervical manipulation as performed only by a chiropractor to the point where it slandeered the profession. If what I hear is true he has been very irresponsible and inaccurate in his expressed views of the chiropractic profession.

As far as the studies are concerned… well I am just a grunt. I treat my 30 patients a day, many of whom are referred by allopathic colleagues, and go home to my family. I used th evidence to guide my practice via continuing education but I do not have it stacked up on my desk. I am well read but I do not every lit on the tip of my hand to fire off to you. I also am not getting into a lit spit match with you guys. I am not getting bogged down in the structure of the studies, etc. Forget it. I worry about what works in my office. You are the skeptics, you do the research.

I will say there is much more evidence than you know though. First you need to stop only using the word “chiropractic” when you search. It is not a procedure or treatment protocol. It is a profession so it does not appear in the data often. You also need to understand that chiropractors are very well trained in a wide array of physical medicine modalities, neuro rehab protocols, and natural medicine protocols.

For example…the ample growing evidence showing how important Vit D is allows us to use it more in our practices… but you’ll never find a paper on “Vitamin D and Chiropratic” but will you find other papers that would be applicable by a chiro in a natural health patient population. Same for Omega 3. Niacin. etc, etc, etc. Correct?

Querty- you’re having hard time understanding all this, aren’t you?

I believe it has only been in the last decade or two where this has even been accepted as part of a formal medical education let alone medical practice.

Evidence please. People griping about their doctors harping on about them about diet and exercise has been commonplace for much longer than the last decade or two in my experience…

Maybe it will help if I step back and explain from the beginning precisely what my problems with the practice of chiropractic are, since I think I have failed to communicate clearly. Essentially they fall into two categories.

The first is the persistent and widespread use of non-evidence-based treatments. This includes the use of manipulation for conditions it cannot help (e.g. allergies, high blood pressure); general treatment for conditions where chiropractors cannot provide adequate care (e.g. high cholesterol – standard basic diet and exercise advice is all well and good, but without, for instance, the training and ability to effectively prescribe statins, including knowing when they are needed and monitoring of their use and effects, such care cannot be considered adequately comprehensive in the general case); and the offering of treatments that have no established efficacy beyond placebo for anything at all – acupuncture, homeopathy, etc. A particularly dangerous form of this is the advocacy of anti-vaccinationism.

In its direct form, this is only an indictment of the particular chiropractors who practice these methods, which I agree is not all. However, the fact that the practices persist demonstrates that the chiropractic profession is not effectively self-regulating to protect patients from unsafe and ineffective “treatments.” And that is an indictment of the entire profession. More, so long as these practices remain in force throughout much of the profession, the general practice of chiropractic cannot be considered to be safe or effective. Even when there are properly evidence-based chiropractors available, how is the average layperson supposed to distinguish them from the quacks?

The second big problem I have is, let’s say that all of that could be dealt with. A chiropractor who restricts his practice to being properly evidence-based essentially becomes a PT with more restricted scope and a pile of anti-scientific baggage. And then one has to ask, what’s the point? Subluxations and woo are really all chiropractors have to bring to the table to distinguish them. Take those away, and there’s really nothing unique to offer, and the motivation for the profession to exist vanishes.

I’ll finally comment that anything chiropractic was able to accomplish in the 30s, much less earlier, impresses me not at all. Before mainstream medicine became thoroughly and properly science-based, it had a lot less to recommend it. But today, the power and efficacy of science-based medicine is so great that alternatives have a much steeper slope to climb in order to have any relevance at all.