Skepfeeds-The Best Skeptical blogs of the day

A “plethora” of evidence for chiropractice

Posted in Journey Through a Burning Mind by Skepdude on June 23, 2009


h yes. The British Chiropractic Association has finally released the “plethora” of evidence that support their non-bogus treatments, and that put Simon Singh in his place. Indeed, BCA has produced an immense list of… 29 references*.

This vast amount of conclusive trials prove the efficacy of chiropractice for the conditions mentioned in Simon’s article beyond any doubt. One can understand why it took the BCA more than a year (after they chose to file a lawsuit instead of resolving a scientific and public health debate using -gasp!- science) to present their evidence: it was purely a matter of logistics! Someone (oh the hero) had to dig out and collect this abysmal number of references. I can imagine the endless hours spent in trying to order and arrange the list -presumably in order of importance (?)

Which makes the very first reference the most important piece of evidence that chiropractice is effective and safe. The Ace of Spades for the BCA; the mother of all evidences; the Optimus Prime of research pieces that completely thrashes Simon Singh’s unfounded claim. This masterpiece is none other than the General Chiropractic Council’s… code of practice!


Not much to discuss here really. This is a truly pathetic evidence base, as Prof. Colquhoun notes, that if anything, totally proves Simon’s point: there is no solid evidence to back up a practise that claims to treat potentially serious conditions… in babies! If you cannot realize the seriousness of this issues I suggest you have your head checked by a homeopath and your spine manipulated by a chiropractor…

The Lay Scientist has a great post up, destroying the BCA’s “plethora” of evidence and providing a plethora of references to other bloggers that were quick to dissect BCA’s document. It’s funny though to go through BCA’s list through the eyes of the Lay Scientist, to try and understand what they think constitutes good evidence in the arena of public health. So let’s do that, shall we?

We start with 29 references:

Of the 29 references, 1 is just the GCC’s code of practice; 6 is an irrelevent paper about medical ethics; 8, 9, 10 and 17 are about osteopathy; 26 is a description of evidence-based medicine; 27, 28 and 29 are about NSAIDs. That’s 10 down straight away, but what’s interesting about these is that 6 of them are just attacks on conventional medicine. In other words, this is not a particularly comprehensive or focused review of the literature.

We are down to 19 already.

A further three papers, (12, 13 and 14) cover the safety of chiropractic, which has come under considerable criticism. Curiously, this brief selection ignores the numerous studies showing an increased risk from chiropractic. 14 isn’t a study at all, 12 is considerably less bullish than the BCA suggest it is pointing to a significant number of side-effects “with a possible neurologic involvement”, and 13 provided stronger support (”We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”), but should be taken in the context of the wider range of studies finding the opposite.

Down to 16 possibly relevant.


One Response

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  1. A chiro said, on June 27, 2009 at 3:24 AM

    It seems to me that some major problems with chiropractic research are being overlooked.
    All scientist know that the randonised, double blind control trial is the gold standard in medical research, and it seems only a positive study of this design could support chiropractic; can this ever work?

    Firstly, clinician blinding. How, exactly, does one blind a chiropractor as to whether or not they are treating? Impossible, right?

    Next, blinding the patient. What exactly constitutes a convincing placebo for a chiropractic treatment? Please bear in mind that chiropractic is more than manipulation.
    There is no convenient sugar pill that can take the place of a good chiropractor, no easy and obvious method of proceeding, so, therefore no double blind trials.

    There are other stumbling blocks, and not all of them involve money – although the fact that no huge pharmaceutical company stands to make a fortune for its shareholders does mean chiropractic will always be the Cinderella of the research world.

    Each chiropractic treatment is indivdual. There is no pep formula – “uncomplicated mechanical LBP, manipulate L5 right side down”; it doesn’t work like that. Alot of my treatment decisions are based on what I feel under my fingers and what my patients feel inresponse to my palpation. That may sound unscientific, it may not be measurable on an instrument, but most of my patients know that my fingers can find a problem. Can I prove this? No. Is it amiable to vigorous research? No. I can write up a case study when I have an interesting or unusual set of findings to let other chiropractors know – this is the first stage in prompting research – but it seems here that case studies are just to be treated with scorn. Chiropractic isn’t a one-size-fits-all approach, so measuring the benefit or otherwise of manipulating L5, for example, will never measure the benefit of chiropractic; so we find another massive barrier to successful research.

    So, I decide I am ready to do some research. I have a small private practice. How do I proceed? Can I enrol 200 people on a research project, carry out a series of 10 treatments free of charge, admiinister a placebo somehow?….no, I can’t afford to! I don’t have enough patient volume to assemble a homogenous group anyway -I am not running a large medical centre or hospital.
    What I can do is administer Outcome measures to my patient cohort before and after treatment – which I do. Overall, the outcomes are extremely positive, but as there is no natural history group ( I cannot really afford to turn away every other patient and then ask them not to seek other help and keep in touch!), I am sure the criticism would be that all of them would be better anyway – good old Dr Time.
    If our critics have a good solution to these problems, the profession would welcome them I’m sure. In the meantime, remember “not yet proven” is not the same as bogus.

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