Skeptics like Edzard Ernst remind me of Humpty Dumpty in their use of words.They make them up as they go along.

October 21, 2012
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Have not blogged for a while. Funny how your priorities change when faced with the possibility of a premature end. About two months ago I was given the all clear, which means 12 months after surgery and having finished six months of chemotherapy I am still alive, no longer have a colostomy bag and there are no visible signs of cancer in my body. Chemo has caused a peripheral nuropathy in my hands and feet which I am slowly recovering from. In May I was palpating a clients spine one Monday morning and suddenly could not feel any “subluxations”. For a few days I was concerned that the skeptics were in fact right, and I had been delusional to believe that I could palpate spinal joint dysfunction AKA, (subluxation). However when I could no longer button my shirt, I was referred to a neurologist who explained that I was not delusional and how chemotherapy had damaged sensory neurons in my hands and feet, it might take years to recover and there was nothing that could be done.  Hopefully I will prove them wrong, I am playing Golf, tennis and working again ( not as well as before, but getting there). If ever a statement was true, it is; “if it does not kill you, it will make you stronger” applied to chemotherapy. My plan now is to demonstrate the truth of this in May next year, by completing the endurance marathon on the Great Wall of China, only twelve months after finishing chemotherapy. At the moment I am in Cape Town and it is raining, I am here because of the possibility that this could have been my last summer of doing exciting things with the kids and Africa is the place to be . The weather so far has not been great, the kids have gone to bed. I have not brought much reading material and was surfing the internet and found this new blog by Edzard Ernst http://edzardernst.com/2012/10/chiropractic-lessons-that-have-not-been-learnt/  responded to it (blue wode described this as an attach this evening on twitter) and felt a blog coming on.
Just as I love getting up Ernsts nose, he loves winding up chiropractors, and when they complain, he wears their complaints like medals of honor. The opinions that should matter most to chiropractors are those of their clients. Ernst et al say we need more research to “prove” what we do, he has convinced the leaders of the profession that this is what we need, when in fact what we do need is more people “liking” our product on platforms like Facebook and sharing their satisfaction with their friends, its called “word of mouth” marketing, its how chiropractic has grown, how Simon Singh got the BCA to withdraw their libel claim. Now if chiropractors are going to take on an opponents dont let them decide the subject, or set the parameters of the discussion. If you have skilled hands, you know chiropractic works, so be patient and opportunities will present themselves.  As when Ernst thanks fellow “skeptic” Blue Wode for his support in the comments on the blog, by saying; “Thank you BW; this explains very clearly why chiropractors will find it hard or even impossible to free themselves from their long tradition of quackery”

As “skeptics” have tried to redefine what it is to be sceptical, they would also like to redefine what it is to be a “quack”. I recently discussed this with Simon Singh who like most of the “skeptics” use this as derogatory term to describe practitioners of Complementary and Alternative Medicine”. By all means skeptics can call me an arsehole,they can have an opinion that chiropractic education is bullshit. But if I am an expert in that subject and restrict my opinions to that subject, they only show their ignorance, calling me a quack, they make this mistake all the time and remind me of Humpty Dumpty’s use of words. In fact by trying to discuss the subject of chiropractic without any expertise and using the biomedical model to analyse chiropractic, skeptics render themselves open to to the more appropriate title of “Quack”or as we Irish might call them “crackt”.

Below, is how I explained my point to Ernst in the comments section on his blog and would encourage others to stick to their strengths when debating with him. Published research is only one of the three  pilars that David Sackett built his model of “evidence based medicine” , its the only one Ernst ever talks about, because his view of patient values or a chiropractors experience are irrelevant  However you may have to  accept that there is an argument for addressing chiropractors who want to prescribe and be a subset of manual medicine as “quacks”

The definition of quack from the Oxford Dictionary
noun
“a person who dishonestly claims to have special knowledge and skill in some field, typically medicine”:

It would appear “quacks” are people who pretend to have expertise in subjects they know little about, presumably subjects like, chiropractic medicine or acupuncture. I practice chiropractic, I dont diagnose or treat illness or disease, I dont make medical claims. You may not like chiropractic or understand it, however practicing chiropractic would not appear to conform to the definition of “quackery”, however claiming to have “special knowledge” about chiropractic and having only been trained as a medical practitioner may in fact make you a “quack” professor Ernst. All I do is maintain movement in spinal joints that become stiff from sedentary lifestyles, movement effects function of mechano receptors(nerves) in spinal joints. You may not believe that is possible, you may not believe maintaining joint function is important or that it effects wellbeing, you are perfectly entitled to your opinion, however I am not so confident of you depth and breath knowledge in anatomy and physiology. You might start by asking, why joints were immobility post surgery in the 80s and now post surgical treatment is all about maintaining joint motion as chiropractors have been advocating for years.

You will find dirt by scraping the bottom of any barrel, you are welcome to visit my practice and quiz my clients any time you like, you may even check my cellar for “victims” of spinal manipulation.

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

    I tend to take the view that absence of evidence is not evidence that it could not work, where there is an an anatomical and physiological explanation to support a theory as to why an intervention might work. Ernst seems to have divided health interventions into two groups Conventional (good) and Alternative (bad), so certain interventions which are more acceptable to the medical establishment but without a strong evidence base as defined by his hierarchy of evidence (see below) and might be described as complementary to medical interventions like massage and physiotherapy for example, he tends to be positive towards and less sceptical. I would say the way he would use the term “sound evidence” would reflect this bias rather than the evidence measured by his “hierarchy”. Thats just my opinion of him, he likes to wind up people who dont share his worldview and generate controversy, because that fuels the debate and keeps him going. Its probably better to ignore him as I have yet to hear him say he is wrong about anything, like his latest post where the title was inappropriate. He would like to think I dont like him because he questions what I do, I have no problem with that it challenges me. What irritates me about him and many academics in my own profession is they are often such know all’s, they have rarely been successfull in practice, retire into academia and them believe they can make good experienced clinicians better. If someone asked me the most effective way to stimulate peristalsis without laxatives I would say, chili peppers, then running not aware anyone has researched this perhaps its just common sense. I would have thought any manual therapist with a good knowledge of anatomy could help someone who was constipated. After my surgery I had a colostomy bag fitted and I developed painful colic because of the pressure build up, it was a combination of massage and manipulation got my bowel moving. If it was an unskilled practitioner all the research in the world would not have made it happen.

  • A N Other

    Hi Richard,

    As someone who has numerous discussions with Prof Erns, I would love to have your opinion on a discussion i was having with Prof Ernst on his
    Blog. This discussion focused on the following issue:

    I think the following sentence is the crux of the matter.

    “Massage is backed by reasonably sound evidence not
    just for neck and shoulder pain but for a range of other conditions as well.”

    Any
    reasonable and rational person would conclude that the links to those studies
    within the context of that sentence means you are saying that there is
    reasonably sound evidence for massage in the treatment of constipation. I think I have shown that is not true. So, I do see that there is something wrong
    with that i.e. you cannot support a treatment for a condition that does not
    have good evidence for.

    Prof Ernst felt there was nothing wrong with saying that there is
    reasonably sound evidence for massage in the treatment of constipation,
    where as i think there is not enough evidence to give such as
    statement. Prof Ernst would not answer my views.

    I would love to have your opinion.

    Many thanks

  • fedup

    The great Andy Lewis aka la canard noir is such a know all when he has a pc and wikipedia infront of him and 10 hours to research his biased opinion, but ask him to go toe to toe with somebody that actually knows a bit about the subject and he hides behind his pc and writes a “letter” giving his view point. A clear case of an online skeptic talking the talk but really knowing not a lot about the subject.

    From his blog.

    “And I happy agreed to let Mike know what I knew of the subject. I was asked if I wanted to take part in the programme, but I had strong reservations when I heard that Emeritus Professor Denis Henshaw of the Human Radiation Effects Group at Bristol University would also be taking part.” so he didn’t take part.

    What a biased professor??? FFS what is the world coming to? I didn’t think such a thing could ever happen.

    And heres another one.

    “This is a guest post from vet, Simon Baker. It is timely for me as last week I turned down the offer of being interviewed by the BBC on a subject concerning quackery. I knew who I was ‘up against’ and struggled to see how such a report could ever be accurate and appropriately balanced.”

  • fedup
  • Pingback: Skeptics like Edzard Ernst remind me of Humpty Dumpty in their use of words.They make them up as they go along. « roberrodris

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  • http://op12no2.me/ Colin Jenkins

    I remember the linked-in thread – it was epic! I think the problem is the shape of the distribution of modalities – all professions have a spectrum but usually the centre mass is dominant enough to prevail – in chiropractic it’s flatter and ends in a self destructive civil war.

  • Richard Lanigan

    This discussion is going on in hundreds of discussion
    forums and blogs on the internet. I have participated in a few of them. the
    biggest was in Linked in with hundreds of contributes. Its like watching a dog
    chasing his tail both sides are so entrenched with their particular point of
    view they can not see that most of what they are getting worked up about is
    semantics. What to call the lesion that chiropractors adjust, and whether by
    correcting this lesion, you improve wellbeing or only musculoskeletal pain
    syndromes. Then you have the ones who are not very skilled, and want to start
    prescribing. The best article I have read on this was written by a good friend
    of mine Chris Good http://www.journalchirohumanities.com/article/S1556-3499(10)00030-6/fulltext
    My interpretation of this is that the hatred comes from the extremes of the
    profession who are also the most motivated. The “centrists” who make
    up the majority of the profession do their own thing and stay out of the
    politics and if these chiropractors dont take control of their profession it
    will never change and your prediction will come true. Its funny I put this to
    some chiropractors who are on the medical wing of the profession. They claimed
    they were the centrists and Ernst represented the extreme medical point of
    view. They just dont get it

  • fedup

    Of course, scientific data can be interpreted in many
    ways. However, the most simple and reasonable explanation of the above results suggests the following:
    I Vertebral artery elongations during neck manipulations are always well within the elongations observed
    within the normal range of motion.
    II Vertebral artery elongations during neck manipulation are always much smaller than the elongations
    that cause first mechanical failure.
    III Finally, for the elongations observed during neck
    manipulation, there are no measurable forces (stresses)
    acting on the vertebral artery.
    Based on these, to our knowledge, first ever results of
    vertebral artery mechanics during high-speed, low-amplitude treatments, we draw the following conclusion:
    I It seems highly unlikely that a spinal manipulative
    treatment to the neck tested here can cause mechanical injury to a normal vertebral artery.

  • fedup

    Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.

  • fedup

    Good bit of research here.
    http://www.ncbi.nlm.nih.gov/pubmed/22483611
    I’ve put it on Prof Ernst new site but its awaiting moderation. lol

  • http://op12no2.me/ Colin Jenkins
  • Richard Lanigan

    Cant disagree with you there Colin, its those divisions that make the profession vulnerable and why the mass complaints worked against chiroprators but never got started against osteopaths. My son was talking about becoming a chiropractor, I said train as a physio, similar education as you would get at AECC and opens more doors and I can teach him chiropractic. However the college in Barcelona offers some hope, so i am keeping my fingers crossed.

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    Skeptics are not traditional chiropractic’s problem; other chiropractors are – as evidenced by the current education at AECC and WIC etc. Globally, chiropractors are all fighting for the same label and the profession is imploding as a result; the skeptics need simply just sit back and watch…

  • Chris W

    Good on your Richard. People like Edzard will only pontificate to people who have no idea what a chiropractor really does or what their education consists of. Anyone with a negative bias about anything can find snippets on the internet to support that bias. He tries to equate the term ‘manipulation’ with chiropractic. This is not the case obviously. Most studies which use manipulation do not use chiropractors to do the manipulation so how can a conclusion be made about chiropractic? Keep up the good work Richard

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