Despite the damage done by the BCA the chiropractic profession should not seek “legitimacy” through the biomedical model

May 1, 2010
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”The time has come for complementary medicine to turn away from the need to obtain legitimacy from orthodox medicine by adopting its paradigm and research methods”

David St George, Consultant/Senior Lecturer in. Clinical Epidemiology and Public Health Medicine at the Royal Free Hospital in London (2000).

There were many interesting responses in the “Rapid Response” section of the BMJ articles about libel and science. Unfortunately few of these responses were by chiropractors who seem to be taking the leaderships advice to keep heads down, which does little to the credibility of the chiropractic profession.

 imageggs Last summer President of the BCA Tony Metcalfe advised chiropractors to “keep this issue in perspective”. He asked chiropractors; “how many of your patients are aware of what is going on? I can tell you that none of my patients have raised any issues of concern with me and are not in the slightest bit interested in the Singh legal action” . That must be how Tony justified doing nothing when I told him how the GCC was covering up the activities of the deputy registrar Greg Price and when more and more vexatious complaints were being made to the GCC about his members. Remember Tony is a  former gamekeeper who was sacked by the voters and is hanging out and representing the poachers until he gets another chance to be on the gamekeepers council again. New BCA president Richard Brown wants to ape the biomedical model and get prescribing rights for his members.

I sent this into the BMJ “Rapid responses” in response to an  Edzard Ernst article BMJ needless to say it was not published, they prefered Richard Browns “Plethora of evidence”

Tyranny of Evidence

If Professor Ernst wishes to devote his life to proving chiropractic helps children conditions that account for less than 5% of what I see in practise good luck to him. Much of today’s evidence on treatment will be dismissed  in twenty years, what wont change is the activity is good for you and maintain spinal joint function is essential for spinal wellbeing.

In 1982 I ruptured my anterior crutiate ligament. The best evidence at the Rigshospital in Copenhagen where Peter Gotzche is a director required that my leg was put in plaster, from my toes up to the head of the femur for three months. Another two months before I could bend it and start the rehab. Knee extensions. The physiotherapists did not realise it was the hamstrings not the quadriceps that provided stability for the knee joint by then the hyaline cartilage in the joint had started to degenerate.

I developed terrible back pain and my GP told me I had a slipped disc and was told to lie in bed for a couple of weeks. On the way home the taxi driver said I should ring his chiropractor, he would sort me out. I choose bed, after three days and feeling a lot worse I dug out chiropractor Ole Wessungs number.

I crawled in and walked out, and have never taken pain medication since. He told me doctors always blame discs but the problem was the Sacra iliac joint. He explained the importance of movement in joints and the effect of stimulating mechano receptors in spinal joints and the effect on nociceptors. I remember him saying medical doctors say sacra illiac joints don’t move. Joe the chemists states “chiropractors cannot alter the relationships among bones in the spine” its nerve function that is altered Joe.

Everything I learned from this chiropractor I put it together and opened Copenhagen’s first Aerobic training and stretching centre “Sweat Shop”. Within a few years I was working with Team Danmark and any sports person worth his salt was doing his physical training with me. No on ever asked about “evidence” the results of my programmes were there for everyone to see. Even the Rigshospital was open to new ideas in 1984 I advised them on equipment for their new rehab unit. They also worked out around then that it was best not to immobilise knee joints as chiropractors had been saying for years. Perhaps I could contribute a chapter in the book for medical students on knee arthritis and why sometimes it is worth putting prejudice aside and listening to experienced practitioners.

In 1990 I decided to study chiropractic at The Anglo European College of Chiropractic and I am certain no junior doctor could access a patient with spinal joint dysfunction (subluxation) as well as a graduate from AECC. After 14 years in practice I would be delighted to compare my skills to any medical doctor or consultant.

If all I do for patients is get them off pain medication and I insist on it with all my patients I have done right by them. In 14 years I have practised in the same area and have never hurt anyone or had a complaint, not bad out of approx 5,000 patients.

How do I do it get patients off pain meds, I show them a picture of David Beckham with ice on his knee. Patient agrees Beckham has the best medical advice money can buy so why is he using Ice and Joe Bloggs is taking Cox 2s or whatever. Presumably because there are no reps going around to the doctors surgeries selling frozen water.

As a registered chiropractor I was forbidden from saying that. The General Chiropractic Council forbids criticising medical doctors so I resigned from the register. Working in the Cuban health care system you learn the patient is paramount, A few years ago the Department of Health was trying to discover how Cuba could provide such excellent health care for $10 per head a capita. I am sure their enlightened approach to what they call “Natural Medicine” is a major reason. Every Poli clinic in Cuba can offer acupuncture instead of drugs.

I was very fortunate to have a tutor like Professor Jenny Bolton teaching me about evidence based medicine. You see Jenny spends her time with her students not courting the hacks of fleet street and may not be so familiar with medical prejudice of Edzard Ernst. Professor Bolton explained why we had to do a research project in our final year “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Sackett et al 2000. He wrote that four years after I graduated. What to these evidence based fascists think students do at the AECC.

Jenny Bolton also said the “Purpose of Clinical research into chiropractic is to improve chiropractic practice not prove it. The quote I remember from Sackett was “Without clinical expertise, practise risks becoming tyrannised by evidence”…. I know what my patients want, they want to be helped they could care less about evidence. That is most important as it is becoming apparent that the majority of the people involved in this debate are not clinicians.

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  2. Richard Brown Vice President of British Chiropractic Association argues that the criticism of his profession is wide of the mark
  3. Wellness and the Biopsychosocial Model of health care.
  4. How can Edzart Ernst be considered an expert on clinical Chiropractic?
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  6. Making the complaint fit the GCC Code of Practice so charges can be brought.
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  10. How are the General Chiropractic Council and the British Chiropractic Council going to deal with Zeno’s complaints

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  • http://spinaljoint.com Richard Lanigan

    I agree with most of what you say and it raises the question medipractors avoid what is chiropractic? Most chiropractors have defined chiropractic to fit their particular technique rather than have the technique they use fit chiropractic. The evidence says chiropractic is good for back pain presumably because stimulating receptors has an inhibitory effect on pain transmission which would mean chiropractic was a very expensive tens machine.

    We should be looking at the relationship between spinal joint function and wellbeing, unfortunately chiropractors who promote subluxation correction and wellbeing will be next target for the skeptics and the GCC. I presume thats why the GCC have removed subluxation from their FAQs. There is no future for chiropractic on the GCC, and its up to chiropractors to take chiropractic away from them and force the GCC to call it “manual medicine”.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    Hi Richard,
    I think that the process of “turning away” is too radical for anyone’s good. But neither is integration to the wrong model. I think that there is more to it in that the original proposition… chiropractic suggests a model which does in my view not contradict integration. What I mean: the spectrum across which chiropractic establishes itself in a sound and respectable manner (unlike attempts to integrate as currently suggested) is the axis from “perfect ability to cope to no ability to cope”. A spectrum within which at one end illness (and not dis-ease) can occur in the person without subluxation (to put it into the original lingo) and some subluxations are so badly entrenched in the psyche or the chemical/biomechanical physicality of the person that it cannot be adjusted by the tools of the chiropractor. Secondly, after accepting that we play a role in that mid-section of the spectrum (although I am by no means implying that the size of that population group is equal to 1/3 of the overall population, in fact I would suggest that percentage-wise we are looking at something more like a 15-70-15 distribution). Chronic lbpx in my opinion largely (but not exclusively) exists in this mid-section. Then comes the next problem for the current state of chiropractic: spinal mechanisms do not in my opinion cause/perpetuate/sustain all of these chronic low back pain cases. In fact dysfunctional mechanisms in isolation (as a sole causal mechanism) are probably only responsible for 50% of back pain of biomechanical origin. And to finally untwist the knickers totally: not all of those (biomechanical mechanisms) are spinal mechanisms either. Other obvious mechanisms would be gait and malocclusion. So to recap (with very wet-finger-in-the-air stats): 50% of chronic lbpx has one causal mechanism, 40-50% of which is spinal, the rest of which gait or malocclusion. The other 50% of chronic lbpx cases are poly-causal and addressing only one part of the mechanism will lead to dissapointing results (both in terms of level achieved and in terms of stability)
    So in summary; even if we are talking about simple chronic low back pain (as the NHS really wouldn’t have any interest in spending money on acute lbpx as it isn’t spending any on it at the moment), the proposal of some for chiropractors to become medical manipulators will lead to poor results and for them to eventually get booted out of teh system for being deemed “not cost effective”. By that point of course it will be “chiropractic” that is then deemed to be not cost effective, having omitted that chiropractic was left behind quite some time ago. Only a return to its core philosophy and values will save chiropractic, even if it means renaming it, changing some of the language so as to be more up-to-date, whilst ridding it from historically acquired flaws. Effectively making it a “brand-new” profession. Personally I feel that “they” should be the ones having to rename themselves as “they” are the ones changing the story…
    Kind regards,
    Stefaan

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