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Patient Media, Inc.

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 a positive effect. So, ignore the countless personal experiences you and other chiropractors have had with subluxated bedwetters, asthma sufferers, and 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 just what health complaints have passed muster and have enough “proof” to warrant 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; he must be rolling over 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, let’s! 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 was due to patient after patient 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.

Originally posted May 27, 2010