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RCT and the Cult of Scientism

rct.jpgIf you’ve had your head down helping patients, you may not be aware of a dangerous trend taking place in the United Kingdom. There, under the heavy hand of the General Chiropractic Council (GCC) regulatory body, many chiropractors are discovering that they cannot promote chiropractic for any health problem other than those proven by randomized clinical trials (RCT).

In other words, the fact that subluxated, colicky babies often respond to chiropractic care cannot be mentioned because there aren’t any RCTs of sufficient quality to “prove” that chiropractic care administered to infants with subluxations has any effect. So, ignore the countless personal experiences you and other chiropractors have had with subluxated bedwetters, asthma sufferers, those oppressed with PMS or other conditions. Ignore the firsthand evidence that you’ve experienced with your own eyes and hands. If there’s no RCT to support your experience, you’d better not be mentioning that to patients or posting it on your website!

Apparently, it’s this clarity, made possible by ignoring millions of cases, that makes so-called “evidenced based chiropractic” so safe and appealing.

It gets worse.

You might be curious to know what health complaints have passed muster and have enough “proof” that chiropractic is helpful:

Acute low back pain • Acute whiplash-associated disorders • Acute/subacute neck pain • Adhesive capsulitis • Cervicogenic dizziness • Cervicogenic headache • Chronic low back pain • Chronic neck pain • Hip osteoarthritis • Knee osteoarthritis • Migraine headache • Patellofemoral pain syndrome • Plantar fasciitis • Shoulder girdle pain /dysfunction • Tennis elbow
The latest proclamation from this governing body is that there is no RCT, or as they put it, “Evidence of the Highest Standard” for the “involvement of the Vertebral Subluxation Complex in health concerns.”

In other words, this subluxation thing you’ve based your practice and patient explanations on? No proof. Chiropractors treat only biomechanical spinal joint dysfunction and there’s no proof that doing so has any effect on whole body health peripheral to the spinal column. There’s just no proof that organic and visceral health issues can be affected by spinal biomechanics.

Poor Dr. Joseph Flesia, who devoted the last 20 years of his life to the scientific evidence confirming the Vertebral Subluxation Complex, must be rolling in his grave.

Just how does a regulatory body reduce chiropractic to such a purely mechanistic modality? By consulting its “Education Committee,” chaired by a physiotherapist and consisting of a medical doctor and representatives from the two, so-called “chiropractic” colleges in the UK. Based on the anti-chiropractic sentiment of the committee members and the mechanistic nature of the curriculum of both colleges, the following advice was handed up to GCC:

• The chiropractic vertebral subluxation complex is taught only as an historical concept
• There is no clinical research base to support the belief that it is the cause of disease or health concerns.
This self-referential way of seeing reality is breathtaking in its ignorance and bias. Or as B. J. Palmer observed, “Many have the eyesight of a hawk, but the vision of a clam.”

Yet…

Something happens when a subluxated infant receives chiropractic care and colic resolves. Something happens when a subluxated child receives chiropractic care and bedwetting ends. Something happens when a subluxated teenager receives chiropractic care and her scoliosis improves. Something happens when a subluxated couple receives chiropractic care and soon after gets pregnant after years of trying. And it happens, not with every patient, but with a regularity that drug manufacturers can only dream about.

Naturally, I could go on. Oh, lets! For the chiropractic-is-just-a-placebo crowd:

Something happens when a subluxated dog receives chiropractic care and is able to carry on as dogs carry on. Something happens when a subluxated horse receives chiropractic care and becomes more fully horsey.

Something happens! And thousands of chiropractors and hundreds of thousands of chiropractic patients (probably millions) can attest that something happens. Something that doesn’t interest pharmaceutical companies who fund most of the RCTs held as the gold standard! Something that seems largely positive, worthwhile, pretty much side-effect-free and for many, so valuable and beneficial they willingly pay cash for the opportunity to experience it.

I’m guessing that hardened skeptics imagine that busy, vitalistic chiropractors are that way due to brilliant salesmanship. Or the use of scare tactics or some other manipulative tactic to coerce stupid, dim-witted patients to interrupt their busy lives to periodically visit their chiropractor and pay for ineffective care.

Hardly.

And let’s not forget the slur that VSC is merely a quaint historical concept. In case the regulatory agencies in the UK forgot, the profession of chiropractic is based on the innate self-healing qualities of living things, mediated by the nervous system. If you want to pervert it into something that better fits your model of the universe, create your own profession and call it something else. Sure, you may be embarrassed by the flamboyant peccadilloes of the Palmers or its metaphysical aspects, but the fact remains, from its very beginning chiropractic has always been about whole body health. And if things that are “old” are so bad, keep in mind that your precious RCT was first used in 1025 AD to test the efficacy of drugs and other substances. A thousand years later, using RCTs to test chiropractic procedures is like using a breathalyzer to test someone’s blood pressure.

If the motive for using the blunt instrument of advertising regulations to punish chiropractors were because patient after patient was complaining to regulatory boards after having been snookered, misled and abused, I’d be compelled to look past the volitional aspect of the doctor/patient relationship and be first in line to protect the public. But that doesn’t seem to be the case here. Instead, it appears to be just another example of the jealous (“My practice would be successful if those infant-treating chiropractors would just toe the line!”) or the pious (“I’d be busier if those other chiropractors would just stop bringing down the reputation of this profession!”) chiropractor with the time and interest to condemn their busier brethren.

It must be especially satisfying to protect the public from greedy, predatory chiropractors who prey on the sick and hopeless. Simultaneously, for someone so enlightened, it must be confusing to see such high levels of patient satisfaction from a healing art that is unscientific, cultish and simply unproven quackery. It’s ironic that this arrogance, combined with a dollop of self-righteousness, obscures the overwhelming evidence to the contrary—RCT or not.

Read more about aspects of this issue in previous posts:


British Chiroquacktors
You’ll See It When You Believe It
Crossing the Line

Comments (20)

I think I don't care whether or not they cannot promote chiropractic for any health problem other than those proven by randomized clinical trials or RCT, the patient who experienced the healing benefit of chiropractic are the ones who will promote it to other people suffering from health complain listed in your article.

Maybe it's just me but does it feel like we are constantly having to justify ourselves and chiropractic? We live in a country with a population approaching 50% obesity, and drugged up to the eyes. Gardasil has now killed a little boy, thank goodness it is approved for males. We give people statins to lower their cholesterol even though cholesterol is not any sort of reliable indicator of cardiovascular health. On a positive note it will destroy their liver, depress them, and rob them of muscle. We'll pay billions of dollars a year for dialysis as the type 2 diabetes takes out the kidney's but won't pay anything to equip someone with the proactive tools to stay healthy in the first place. What's good about this model? Are the RCT's that deem the drugs the pharma companies produce as good for us really help? Why doesn't anyone else have to justify their dangerous contributions?

As someone involved with the chiropractic profession, even though I don't agree with your logic... I appreciate your passion for the topic and your perspective about "protecting the public from greedy, predatory chiropractors who prey on the sick and hopeless."

Kelli:

Really sorry to hear about the oppression of such a great profession in the UK. Europe has always been extrememly biased towards alternative health anyway. They only worship the Cult of Scientism and the Church of Medical Truth. Science is too slow and prone to error, owned by the corporations that are ruining the world. But the day will come eventually when people will revolt against Big Pharma and Big Food. Europe needs a movement like that, theres been something similar in the US. We need to go torch Big Pharma to the ground. The lives they've taken and junk science they promote is unforgivable. We need to develop are own committee to fight against the skeptic medical mafia thats threatening everyones health. I will not go to some crackpot whitecoat who thinks their god.

Besides so-called "evidence-based medicine" is nothing but experimental quackery with all its poisonous synthetic drugs. The only reason they ever got a foothold instead of alternative medicine is because they terrorized anyone who doesn't agree with them and they can't make a profit off of. And you call that science? No, its nothing but junk science.

Frederic, PT:

This blogpost and most of the following comments demonstrates why chiropractic will never get the credit it thinks it merits.

An incapability to critically and scientifically scrutinize its own rationnals while failing to acknowledge actual scientific knowledge.

Most often, one needs to suspend some basic laws of science and biology to believe in what chiropractors preach.

You guys seen it work many times I guess. Did you know that the plural of anecdote is anectdotes.

But hey! it works so it must be true...

Interesting stuff!
And people just keep referring those they love and want to help to chiropractors!

Amanda, I don't believe that you did get better, after all there is no RCT to support that result, therefore it did not happen! Hopefully you did not pay for that experimental treatment, your results were just placebo!

lol :)

Please remember why RCT's are even used. They determine the risk to reward ratio of any particular intervention.
With the advent of tricky molecules derived from petrochemicals it is imperative that you be as sure as reasonably possible that the intervention will provide enough benefit to counterbalance the negative side effects.
Since chiropractic care has few, if any serious side effects, (please don't drag out ye ol'stroke argument) it doesn't need to be held to the same level of evidence. Simple clinical observation and patient satisfaction levels are sufficient to determine if care is appropriate for whatever the complaint.
Don't forget, the powers that tried to eliminate chiropractic (Comittee on Quackery) havent' gone away, they've just become sneakier.

Amanda Spry:

Reading this article and everyone's comments have been really interesting. There are so many different opinions (of which people are completely entitled to) that I believe you guys have become blinded without looking at the most important part of your jobs - Patients!
I have worked in the clinical trials industry for more then ten years, testing pharmaceutical products on healthy volunteers and patients. Having been at the forefront of this industry I know how long it takes and how much money it takes to get a new drug compound out of a lab and onto the market - 5-10 years and millions of dollars.
I was a big believer of going to a GP, getting a problem diagnosed and popping a pill to make the problem go away. However when the pills I was taking for a lower back injury, sciatica pain and neck/shoulder pain were not working anymore I had to become open to other options. Physiotherapy did nothing so I tried Chiropractic. Within two weeks and 4 adjustments I was completely pain free! I thought that I was cured, so after a couple months (an adjustment per week) I stopped going. My symptoms returned so I continued being adjusted once a week. I have been pain free with no need for pills and potions for 4-5 years.
Chiropractic works - end of story.

"... move with the times and understand that this is a medical profession. Because Chiropractic is a medical profession it is subject to the same scrutiny and evidence based approaches that EVERY science is.

You can not and should not make unsubstantiated claims and use/hijack words (Subluxation) that are ambiguous and subject to existing definitions.

Stop preaching your poison and understand that times have moved on!"

Poison? Hmm... Chiropractic or Gardasil, Vioxx, Celebrex, Percoset, Vicodin, Children's Tylenol, H1N1 vaccine, Prozac, Ritalin, etc.

Get your head out of the sand, Wayne, and take a look around you. If you think talking about the vertebral subluxation is poisonous, do a little research on the aforementioned drugs and vaccines I just named.

I would be happy to be the research doctor that establishes any condition responding to chiropractic better than the alternitive-- just let me know what the placebo is on the RCT? Everyone that critizises the science of chiropractic needs to take a close look at the clinical trials for open heart surgery, root canals, spinal surgery or any surgery for that matter. What are the placebos in those trials? What, there are no RCT for any of these procedueres? WOW-- M.D.'s and Dentists should not be allowed to claim that these procedures can help anyone, in fact to protect the public MD's and Dentists should not be paid for any surgery that has not gone thru a full RCT with 10000 participants.... Just kidding! of course heart surgeries save lives-- even without a RCT. Guess what, there has never been an RCT to establish that parachutes are needed when you jump out of an airplane, but you won't see me jumping out of an airplane without one.

Chiropactic is removing interferance from the mechanism of healing, so the effects of removing interferance from T7 could be as broad as the nervous system itself! You can't just look at a meric chart to design a study-- it is not that simple. In other words chiropractic does not cure anything-- it removes interferance from the system that can cure anything. And that system itself is very plastic as can be seen in stroke victims that rewire their own brain to walk and talk again. the neural connections from a vertibrae are not a single nerve to organ connection-- there are overlaps and multiple neural feeds to every organ.

Having said all that, just like a heart works better with a good blood flow (bipass surg.) dosen't it just make sense that the body works better with a good nerve flow (including vicera)?

Michael Shreeve:

Clem Bezold a sociologist reported about three years ago that we chiropractors have evidence for about 10 percent of what we do. It is interesting that he told us at the same time medicine has evidence for about 10 percent of what they do.
We are in the health care business and not in the business of medicine! Health is restoring function not treating pathology! RCT's do not fit our model however that does not prevent us from documenting what we do.

Thanks for your comments Bill- very astute in my opinion!
We are having some of the same issues with the RCT zealots seeking to restrict the practice of chiropractic.
It always surprises me that the EBM fanatics forget that EBM is supposed to combine the best available evidence with patient/ client preference and the practitioners experience.
How can throwing away 2 of the 3 criteria be in people's best interests?

Edwin Lau:

No offense Wayne but chiropracTIC is not medicine and medicine is not chiropracTIC! Never was and never will be.
I think that most MD's would be offended by anyone calling a chiropracTOR an MD and vice versa.
Medicine has always looked for a cure of all diseases without realizing that cure could not be found in treating an effect.
Chiropractic works with the Innate ability of the body to heal itself.
Plus Subluxation is not ambiguous. It was clearly defined in Volume 18 by the man himself, BJ Palmer.
Subluxation:

1. Misalignment of a vertebrae
2. Occluded foramen
3. Nerve pressure
4. Blockage of mental impulses

It's not poison when you know what chiropracTIC is and is not!

Eric Helson:

I tend to fall into the general classification of the "evidence-based" group within our profession. That said, I have witnessed many stunning results that are not "proven" through RCT. The fact that I have chosen not to overtly promote or advocate these results does not mean I do not believe they occur. I simply have not been able to reproduce them with enough regularity to know, for certain, which adjustment/combination on which vertebrae will have the desired result...in fact, I strongly suspect that this is largely dependent upon the individual being treated- what insults have occurred over their lifetime that has resulted in their current state of being. Therein lies the "art" of our profession.

I should like to point out to those on the Education Committee of the GCC that the mechanism through which aspirin (specifically ASA) acted was not understood until 1972. Yet it was still widely used. If memory serves, the two gentlemen who are credited with "discovering" the mechanism of action were awarded the Nobel Prize for Medicine that year.

Much of what we do now has roots in "unscientific" history. Trial and error. Modern medicine is, once again, using leeches for certain maladies. Herbal remedies, known to be effective for thousands of years in some cases, passed down verbally from one generation to the next, are once again coming to the fore as our modern pharmaceuticals create more complications.

This is not to say that studies, trials and research are not valuable. But let’s not throw the baby out with the bath water. Modern medicine has purpose—a fact I am reminded of every day that I am blessed to wake beside my wife who was diagnosed with and treated for an aggressive form of breast cancer two years ago.

To those on the GCC and their Education Committee, a question: Where would we be today if not for those brave souls- from all professions- who boldly set foot where others feared to tread? Where does research begin? It begins in the offices of the everyday practitioner; filters through to the research oriented amongst our profession; then onto study after study after study—before it can be "declared" proven. Many years and much money are required to accomplish this. And what of the hope that would have been offered to the parents of that colicky infant? Or the early teen who still wets their bed? Or the husband and wife eager to have their first child? Can Chiropractic help with all of these cases? Certainly not. But can it help some? Definitely. We do not know which we will help, but to deny that hope, in the absence of any real risk of harm, is not right.

As was stated at a Coroner's Inquest not long ago (by one of the expert witnesses): "...if we are to hold all treatments for ANY condition, in ANY profession, to a level greater than a risk of 1 or 2 per million (the then current accepted rate of incidence for stroke/stroke-like symptoms following cervical spine adjustments), then we are going to throw ALL of HEALTHCARE back to the dark ages."

Dirk Jacobsz:

I love the science of medicine. look how it has helped my family.

My Mom was given medication to stop morning sickness. Thalidomide. ... tell my brother with deformed arms..

My aunt had mental health issues .... but an ice pick in her eye .. a prefontal lobotomy sorted that out.

My dad had a heart attack in the 70's and was sent to bed as treatment of choice for 3 months of "bedrest".

My uncle went to the Nuffield Orthopaedic Hospital in Oxford UK in 1985. The finest orthopedic surgeons examined him and after 8 weeks of total bedrest decided to fit him out in a plaster of paris jacket from under his arm pits to the top of his pelvis. To stabilse his spine.

My niece in Perth Australia recently had her baby vaccinated against the "flu". Her baby had a severe reaction to the vaccine, but did not die like some others did.

These are not members of my family but patients I know.

Now we hear of the death of the subluxation. And the GCC policy statement that there is no such thing as a subluxation as it is unscientific.

Stand up chiropractors and be counted.

Lara:

It is a step backwards that the GCC has banned the use of the term VSC in any advertising material. The term VSC describes a collection of objective findings a chiropractor looks for before adjusting the patient. If chiropractors are restricted to only what RCT's show then practice would be severely limited indeed.

Evidence based practice is not just about RCT's, but should also include clinical and practitioner expertise. As described by Sacket et.al.

In regards to Wayne's post about I always thought that Chiropractic was a health profession not a medical profession.

As described by The Wordsworth Concise English Dictionary;
Medicine; any substance used (esp. internally) for the treatment or prevention of disease: a drug; the art or science of prevention and cure of disease, esp. non-surgically: remedial punishment: a charm, magic; anything of magical power

health: sound bodily or mental condition: soundness: well-being: state with respect to soundness

I think I'll stick with the health and wellness paradigm rather than use any magical powers

Thanks, again, Bill, for keeping this issue in the limelight and making the case.

Is there anything specific we can do from the States to support the cause for a Chiropractic mentality in the UK?

Here it's always about using your dollar vote and your vote as well as being a model and doing what you can on a person to person basis. What else in this situation?

And why is there essentially silence around the issue, here on your blog and elsewhere in the US? I just flipped through the most recent issue of Dynamic Chiropractic and there was no mention. The other chiro stuff that comes to the office - product pushing magazines mostly, don't cover it enough to get my attention. (It isn't on their covers in other words.)

“Chiropractic is a philosophy, science, and art of things natural; a system of adjusting the segments of the spinal column by hand only, for the correction of the cause of dis-ease.” —Palmer
Pretty simple-in fact too simple to the 'wise.'
After 22 years of observing miracles week in and week out, I see frequently the things some would call 'unsubstantiated claims.'
Why are some so focused on medically funded 'research' and not in awe of the recuperative possibilities that lie in wait for a spine be freed of subluxation?

Wayne:

'Something happens' when a ----- gets a vertebral subluxation adjusted?

Yes thats good science and medical fact!

Lanigan, move with the times and understand that this is a medical profession. Because Chiropractic is a medical profession it is subject to the same scrutiny and evidence based approaches that EVERY science is.

You can not and should not make unsubstantiated claims and use/hijack words (Subluxation) that are ambiguous and subject to existing definitions.

Stop preaching your poison and understand that times have moved on!


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From May 27, 2010 1:07 PM

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