Just goes to show how little Professor Edzard Ernst knows about chiropractic

September 24, 2010
By

 

Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter and in his latest article in Pulse he announces to GPs the revelation that “There is a Division in UK Chiropractic” .

Correct me if I am wrong here. Is this the same Edzard Ernst who for years has presented himself as an authority on chiropractic and the theory which it is based on. All this knowledge and he did not know the profession was split into two camps. In doing all his research into the efficacy and risks of chiropractic, he must have interviewed  a few chiropractors to draw his conclusions and he would have us believe he did not know there were two approaches to chiropractic practice. 

Of course he knew, however this time his effort to scrape the dirt from a barrel is pretty obvious. Ernst does this all the time trying to make  regurgitated old stuff sound new. In May Ernst told his readers I had criticised him unfairly in my critic of his New Scientist article. He is entitled to his opinion but what I find particularly galling is having read my critique to repeat the lie in the latest Pulse article  “It seems that UK chiropractic is heading for a division: the ‘fundamentalists’ are likely to adhere to the dogma of their founding fathers. Thus they might believe in the notion that ‘subluxations’ are the cause of all human diseases and treat them with spinal manipulation”.

This is my part of my critique Ernst read back in May; “DD Palmers’s hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask.

I have written many articles about this use of the word disease in relation to chiropractic and this is a classic example of people quoting Palmer selectively and out of context.

DD Palmer wrote one book “The chiropractic Adjuster” His son BJ wrote many and collectively they are called “Green Books. The book that most accurately describes the teachings of the Palmers was written by R.W. Stephenson’s in 1920 he compiled his list of “chiropractic principles” in his“Chiropractic Textbook”, BJ Palmer praised him for compiling the principles of “my writings into systematic organised manner so anyone could easily find “what chiropractic is, Is not; What it Does and does not; how and why it does what it does not” Lets see exactly what Palmer says about disease.

Modernist chiropractors and sceptics deliberately interpret the principles literally without reference to the time they were written in or the language of that time. The best example is the way they ignore the little weeny hyphen in Palmers dis-ease (Principle 30 “The Causes of Dis-ease”). Stephenson clearly states in the book “Disease” is a term “used by physicians for sickness. To them it is an entity and is worthy of a name hence diagnosis”.

Stephenson describes Dis-ease (with a hyphen) as “a chiropractic term meaning not having ease. It is a lack of entity It is a condition of matter when it does not have property of ease. Dis-ease is the condition of tissue cells when there is uncoordination”. Stephenson goes onto say, “if tissue cells are not coordinating some tissue cells will be made unsound, therefore they are sick and not at ease. By deconstructing chiropractic down to a vitalist level of cell communication we are going beyond nerve interference and into the realms of neuroscience that Candice Perth would describe as the “molecules of emotion” 80 years later. Anyone who would state “subluxation chiropractors” claim to cure all “disease” is either disingenuous or ignorant. I have no idea which one applies to Professor Ernst.

imageI would now add having read the explanation of dis-ease he must also be dishonest in  writing what he did in the latest pulse.  He is obviously prejudiced towards chiropractic rather than simply skeptical. Steffann reminded him of how little he knew about chiropractic in June on  Ernsts Pulse blog has Ernst got any new information has he found a chiropractor claiming to cure all diseases since then. Why let facts get in the way of a good story for his septic disciples.

I remember reading his first article in the Independent in 1998. Prof Ernst was concerned that much of what was being reported on the complementary medicine seemed to stem from an “extreme pro or an extreme contra” . Ernst told readers that he had decided to stay out of the “media battles and focus on discussions in scientific publications publication” however he could no longer remain silent and decided to make an exception to this rule”. Why? The reason he said was simple in his view “the debate has gradually become ill-informed, misleading and seriously unbalanced”.

If anyone has contributed to misleading the public about chiropractic it is Ernst with his wild claims regarding the dangers and ineffectiveness of chiropractic. Much of his information has been gleaned from American websites like chiro base which has inspired him to do some studies none of which have been repeated by an credible researchers as far as I can see.

Its one thing not to be good at what you do but to deliberately to provide untruthful information to make the point he wants to get across shows that he is no better than a tabloid hack. Professor Ernst is not blind he chose to put those stones on his eyes and he sees what he wants to see about chiropractic because it keeps him in the public eye, not his “research”  or his academic kudus he is just another celebrity rent a mouth. What is truly embarrassing is the difficulty the chiropractic profession has had in shutting him up. I would just love the opportunity to a public debate with this man because he clearly does not know what he is talking about. 

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  1. These are my comments on the article professor Edzard Ernst had published in the New Scientist last summer about chiropractic.
  2. GCC Fiddles While Edzard Ernst Burns
  3. Edzard Ernst Presents his views to the GCC
  4. Ezard Ernst is blaming Prince Charles for costing him his job? Seems Ernst can dish it out, but not so good at taking it.
  5. How can Edzart Ernst be considered an expert on clinical Chiropractic?
  6. Check out sceptics blogs, they are getting very emotional about the fall of their great leader.
  7. Incompetent leadership unable to put Ernst down.
  8. Vacancy for a former medical doctor who did a bit of Woo on the side.
  9. Subluxation – An historical concept? We dont think so ! The UCA starts the fight back.
  10. The chiropractic profession has not been very effective at defending itself from sceptics

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  • Simonetta Logan

    I was on one of his sites when googling JP Barral while I was on a visceral manipulation course. Venomous, ignorant and sarcastic. Why get into any kind of conversation with ignoramuses (ignorami?). A sad narrow minded oaf. His axe is grinding blunt.

  • http://www.chiropracticlive.com Richard Lanigan

    There you have it Ernst has pronounced on chiropractic mantainance even though he does not know what spinal maintanence is. His knowledge and understanding of clinical science is limited to whats in the journals that he likes http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4129859&c=1

  • Fedup

    I found this about research bias.

    “On the cutting edge of science, scientific interpretation can lead to sound judgment or interpretative biases; the distinction can often be made only in retrospect ”

    Right so lets look back at all research on CAM done by E Ernst,
    er negative, dangerous, negative, no better than placebo, negative, dangerous, no effect, doesn’t work.

    I would say that in retrospect all research done on CAM by E Ernst is the latter.

    http://www.bmj.com/content/326/7404/1453.full

  • A N Other

    In response to stefaan’s first comment, i have tried posting a comment on zenosblog but he keeps deleting it. I think it is an interesting view on treating musculoskeletal complaints by Karel Lewit. If it is ok i am going to put it here for people to read.

    “Managing common syndromes

    By far the most common painful conditions of the motor system are those called non-specific or idiopathic because no pathology can be found. The vast ever increasing number of patients labelled in this way are in no way malingerers and adequate clinical examination furnishes a wealth of signs and symptoms to prove the somatic origin of their complaints. Because some motor function can be shown to be impaired, this being mechanical disturbed biomechanics are thought to be the cause, hence the term mechanical disorder is frequently used. This term however is inadequate because the organism invariably reacts through its nervous system:
    In fact any mechanical change is a source of information processed by the nervous system which makes the motor system react in a co-ordinated fashion. Therefore, however, any mechanical disorder may be prominent or even measurable and we have to deal with disturbed function or dysfunction.
    If we apply the methods of rehabilitation including manipulation, relaxation etc. our objective is dysfunction, even in cases in which we find pathology i.e. in disc lesions, treated by conservative methods. In rehabilitation, therefore our task is to improve or if possible normalise function.
    Hence a good understanding of the functioning of the motor system and of “functional pathology” is essential.

    Our first task when dealing with a patient is therefore to decide whether he suffers mainly from a disturbance of function or one of structure.
    • We have to insist that function (physiology) is as real as anatomy (pathology)
    • Even if there is structural pathology there are also changes in function which cause clinical symptoms
    • The clinical picture correlates mainly with changes in function, much less with structural pathology. Very frequently pathological changes do not manifest themselves so long as function is not impaired. However, changes in function by themselves may cause clinical changes in the absence of any (structural) pathology.
    • For the same reason, even clearly diagnosed pathology can be clinically irrelevant (disc herniations, spondylolithesis), whereas dysfunction that can be usually be diagnosed only by clinical means can be of decisive importance
    • If we directed our therapeutic efforts at the pathological changes, our therapy would fail in such cases; however, even if the pathological changes are important, we may still improve the patient’s condition if we improve the function, because this is exactly what can be achieved by rehabilitation. It is , however, necessary to be aware of the limits of what can be achieved
    • The diagnostic task in pathological diagnosis is to localise the lesion exactly and determine its nature
    • The diagnostic task in dysfunction is to determine the pathogenetic chain and to assess the correlation and relevance of the individual links (holistic principle)
    • In pathological conditions, success is achieved by effective drugs, or possibly by surgery. In dysfunction success depends on the correct choice of the relevant link or links of a chain at the right moment.
    • The functional approach is much more difficult, we may compare pathology to the hardware and dysfunction to the software of the motor system
    • Therefore, he who only treats dysfunction at the point where pain is felt is lost and certainly the patient is.
    • Because changes in function are reversible in nature, it can be expected that, if adequately treated (and the case is not complicated), the effect of the treatment is immediate, giving the impression of a “miracle cure”, which however is predictable
    • The relationship between cause and effect usually presents no major problem in conditions caused by structural pathology. However, it can be very subtle in changes caused by dysfunction; what was originally the cause may become secondary and vice versa. Chronic pain of any region will produce changes in motor patterns or stereotypes, which, in turn, will cause dysfunction perpetuating pain. Chronic joint movement restriction and trigger points cause impaired mobility of fasciae, which, in turn, produce joint restriction and muscular trigger points.
    • Statistical methods are very useful in well defined pathology and should be mandatory in this field. It is, however, much more difficult to apply them in changes of function. Even for diagnosis, the same clinical condition (e.g. headache) can be the result of a long chain of various disturbances, the relevance of each link constantly changing. In therapy, if we have treated one link successfully, it would be nonsensical to repeat the same treatment. If, therefore, there are still symptoms left, we have to treat another link in the chain. If the patient is then without symptoms, this by no means implies that the first treatment was of no avail. However, this is very difficult to assess by statistics.
    • Psychology is very important in every type of patient for its influence on the autonomous nerve system, e.g. stress. In dysfunction, however, psychology is part of the pathogenetic chain because the locomotor system is the effector of our mental activity, the organ of voluntary movement. This further borne out by the fact that pain is the most constant symptom and that tension and relaxation play a very important role. It is, however, necessary to decide how relevant the psychological factor is in each case and how amenable to treatment.
    • Modern technology enable us to diagnose pathological lesions much more effectively, even if irrelevant, and also to objectify them. In dysfunction, technology is usually of little use and very cumbersome. Clinical skill remains decisive. This, however, is considered “subjective”.

    The Holistic principle

    This approach was characteristic for all ancient medical systems based on “humours” and for herbal medicine. It is most prominent in traditional Chinese medicine, with its systems of “meridians” stressing interplay and connections between internal organs and points at the extremities and the importance of physical exercise and diet. The shortcomings of this approach was its pure empiricism, sometimes bordering on superstition, and complete lack of scientific proof. This was also true for diagnosis considered in modern times to be the basis of rational therapy.
    It was the success of pathological anatomy that has seemed to prove the true cause of disease in structural, well defined and localised changes which could be demonstrated and verified. This became the hallmark of scientific medicine. Therapy, mainly by drugs and/or surgery, was judged by its effectiveness in normalizing these well defined and verifiable changes. Modern technology not only greatly enhanced our ability to diagnose structural changes but also produced drugs that were much more powerful in specific situations and made surgery much more effective and safe at the same time. These incontestable successes brought about the current belief of the medical establishment, that all medical problems will be solved when we find the pathological (structural) cause of every disease and the specific drug to cure it and hence, their complacence. Anyone who does not accept this model is branded as denying “modern science”, trying to revive the old obsolete empiricism and promote some sort of “alternative” or “complementary” medicine, held to be “unscientific”, even if treatment by their methods proves to be successful.

    This is the reason why many of those who practice methods considered “alternative” are not prepared to adopt whole-heartedly the “functional approach” or “functional pathology”, although they are aware that (at least) 90% of their cases with motor symptoms have to be classified as “non-specific”. They still hope that the “true pathology” will be revealed at any moment. For the same reason, most adherents of the numerous sects of alternative medicine who proclaim a holistic approach do not really know how to implement it. This is no mere coincidence. We have pointed out that the functional approach is more complicated i.e. more demanding than structural pathology, comparing it software in contract to hardware. This also explains why most schools or sects of alternative medicine are system-forming and dogmatic i.e. they simplify the more demanding functional truly holistic approach. This can only be an open system, based on physiology, which after all is even more complicated than anatomy.

    DD Palmer’s “hole in one” theory offers a good example from chiropractic history. He thought that all the problems of the spinal column (if not the whole organism) can be solved by adjusting the atlas/axis or of Illi (the Swiss Chiropractor) who believed in the supreme importance of the pelvis. Earlier chiropractors and osteopaths believed that all health problems were the result of spinal “subluxations” or “osteopathic lesions”, interfering with the flow of “energy” from the brain to the internal organs: simple and satisfying. Once we practice manipulative techniques, however, we sooner or later find that the changes we diagnose (mainly by manual methods) are not just haphazard, but follow certain rules. Very frequently when we treat the craniocervical junction we observe response throughout the motor system, which seem to follow a certain pattern. More importantly, the response are by no ways limited to a particular segment of the spinal column, an accepted tenet of neurology. No less frequently, and quite regularly, we see responses at all levels of the motor system. We thus learned to distinguish “key regions” of the spinal column where treatments was particularly effective in producing such reactions. For a long time these observations were limited to the spinal column, ignoring the feet, hands and the orofacial system, putting the emphasis on joints and under-rating muscles and soft tissues.
    It is therefore seemed important to find out whether there is a rule governing these “repercussions” involving the motor system as a whole.”

    Any comments welcome.

  • Garland Glenn

    I realize this is a bit of a problem for UK trained chiropractors, but the comment about US trained chiropractors needs to be addressed and then put to rest. US trained chiropractors have the right to be called doctor because theirs is a doctorate degree. Anyone with a doctorate ie PhD, DC, MD, DDS etc is by definition a doctor. Stepen Hawking is a doctor. Doctor is ALSO a vocation of doctoring. That is treating patients. So US trained chiropractors are doctors on two counts. By degree and by vocation. On the other hand medical doctors (GPs) in the UK are NOT doctors by degree but only by vocation.

  • Paul

    Just try posting that on his column Fed Up – never had any of my critical statements posted …

  • fed up

    I like how EE states this.
    “Secondly, it shows that US chiropractors now routinely use the term ‘doctor’ to describe themselves – a habit that seems to be increasingly popular in Britain as well. This might confuse patients and give them the impression that chiropractors have studied medical degrees.”

    And the has the cheek to use the title “Professor Edzard Ernst is professor of complementary medicine”
    “A professor is a type of senior teacher; the precise meaning of the word varies by country. Literally, professor is Latin for a “person who professes to be an expert in some art or science, teacher of high rank”

    I wonder if he’s worried about confusing the public? They may actually think he teaches, has studied in, or knows something about CAM.

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

    I know, but it’s along the same lines of seeing something wrong being done and doing nothing just because it seems pointless.
    And I am learning a lot from it all too.
    Many kind regards to all
    Stefaan

  • bemused

    Never argue with a drunk!

  • Rosemary

    Thank you, Garland Glenn, that sums it up nicely.

  • Garland Glenn

    Some people are just stupid and you can’t fix stupid.

  • fed up

    Pure logical thinking cannot yield us any knowledge of the empirical world; all knowledge of reality starts from experience and ends in it. (Albert Einstein, 1954)

  • Rosemary

    A quote from Columbus read out by his son in 1942 – in “the conquest of paradise” – that reminds me to rise above the critical and ignorant attitude of chiropractic skeptics who are trying to limit, even eradicate, chiropractic.

    “Nothing that results from human progress is achieved with unanimous consent. And those who are enlightened before the others are condemned to pursue that light in spite of others.” -Christopher Columbus

  • fed up

    Welcome stefaan fellow troll, I have also been labelled as one. I followed all the skeptic bloggs, commented, tried to explain but you soon learn it’s like talking to a brick wall. For some reason they think chiros make a fortune by duping unsuspecting members of the public. Not that you have a patient base of thousands built on word of mouth referals based TOTALLY on your performance and outcomes. My brother who is both a physio and chiro said to me one day ” why do you waste your time with those assholes?” so I haven’t given them a thought or viewed their bias sites since. They will never affect the way I work and I will never change their minds so, whats the point?

  • CDC

    Thank you Richard for all the work and all the good thoughts. You too, Stefaan!

    I agree with you 100%.

  • http://spinaljoint.com Richard Lanigan

    Hi Stefaan,
    Whats the point, we are just going over the same old ground again and again, with the exact same people. Blue Wode has been at it for years, I have never heard him have a good word to write about chiropractic. You explain what we do, they say where is the evidence we present it they say its not good enough only RCTs will do, which is the only evidence they accept. I can live with that and am happy to agree to disagree with the skeptics.

    They have very little understanding of the anatomy and physiology of the spine so they can not even grasp the theory behind an adjustment, so they hurl insults when you try to explain. I see you have been elevated to a “Troll” wear it with pride. Some of the stuff I have seen written about my views on these blogs is just complete bullshit, one guy even stated I had banned him from http://www.chiropracticlive which obviously made his comments sound credible. People believe all sorts of shit and you or I are not going to change their minds one way or another
    Ten years from now we will look back on this and see how it left the chiropractic profession with no alternative than to come together and focus on what we do; correct subluxations/spinal dysfunction/woo, whatever the chiropractic profession choose to call it and it will be the chiropractic profession not the GCC and their skeptic allies who will decide the future of the chiropractic profession and that must be a good thing.
    So as we build a new future we should thank Zeno et al for highlighting our weakness and focus on what we have in common. It is not good enough to simply question the medical paradigm we must also question our own paradigm. We have one great advantage over skeptics we know chiropractic works effectively we see the proof every day in practice. All sceptics have is their misguided belief that there is no biological reason why a spinal adjustment could effect someone’s wellbeing.

    Thanks to Iain for this: “The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were.”
    John F. Kennedy

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

    Send me a ticket to join!
    What a load of cobblers this man and his acolytes are producing! Join the debate at zeno’s blog http://www.zenosblog.com/2010/09/getting-their-nappies-in-a-twist/comment-page-1/#comment-12735
    Regards,
    Stefaan

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