I have invited a number of people but one professor in particular to answer me this: how can anyone deduce comment regarding efficacy of treatment if none of the studies they refer to differentiate causation? (he said he couldn’t make his point in 140 twitter characters)
My point is: It’s a bit like saying that an antibiotic which kills off a certain strain of bacteria which causes chest infections doesn’t work because it doesn’t cure all chest infections…
It strikes me as utterly ridiculous and odd… It strikes me as obvious that the bravado some people employ to “crack down on quackery” (good on you) is in the case of chiropractic care misguided, founded on quicksand and symptomatic of an unhealthy obsession with pointing out other people’s weaknesses. What I mean is this: when we look at the available research evaluating the efficacy of say spinal manipulation (which a lot of these self-professed quackbusters equate to “chiropractic”),… well, those studies compare the outcome measures of treating a generic non-specific back pain suffering patient with “a” manipulative treatment protocol, compare the outcomes to doing nothing, compared with doing exercise, compared to combining manipulation to exercise etc… Now stop and think about this…. what percentage of non-specific back pain is CAUSED by manipulable leasions? What percentage of non-specific back pain cases is CAUSED by a lack of exercise? And now we’re at it,… what percentage of such back pain cases is CAUSED or AGGRAVATED (please note the distinction the author makes between causal and co-factorial relationships) by anatomical leg length discrepancy/descending malocclusion/obesity/stress-coping strategies to name but a few? Now consider a 100 generic “non-specific back pain sufferers” (I picked 100 just to keep the numbers simple but if you’d like you can think of 100.000 or even 362 if you want it awkward). Of those 100 some will be in the state they’re in because of spinal dysfunction some because of stress, some because of obesity. Manipulating the latter two is in my opinion a nonsense so we’re left with 70 (no factual basis to this figure and no animals were hurt in the writing of this blog) the other 30 are sent out to learn coping strategies and loose weight. The 70 that are left: 35 of them have gait issues to some extent. Some (say 20) have gait issues which cause the spinal dysfunction some have gait issues which aggravate the spinal dysfunction. The 20 are sent to a good podiatrist (please note “good”-this is a salient point) or given an off the shelf solution where possible the other 15 are given the same but concurrently need to have the other co-factors identified and go back in the pool of the 35 remaining non-gait based spinally dysfunctional back pain patients. So those 50 (100 minus the 30 non-spinal dysfunction patients = 70 and 70 minus the 20 referred out to podiatry=50) are then assessed for descending malocclusion problems. 10 of those will have dysfunctional movement patterns (spinal dysfunction) caused or aggravated by descending malocclusion patterns. Of those 10 there are 3 whose problems are entirely caused by this, the other 7 are aggravated. The 3 are referred outo a good splint therapist (again salient point) and the 7 the same but they come back into the pool leaving us with 47 of the 100 whose aggravating factors have been dealt with and 53 whose causal factors have been treated via referral pathways. Those 47, and only those 47 are approriate candidates for the assessment of efficacy of spinal manipulative therapy.
Here comes the joke: even if you manipulate the 100, indiscriminately of other causal and aggravating factors, EVEN THEN does spinal manipulative therapy come out looking like it’s efficacious!!!
There is only one conclusion that can be seriously drawn from the research and that is that spinal manipulative care is an extremely powerful and efficacious technology to address non-specific back pain… but then we already knew that, as chiropractors, osteopaths, osteomyologists and physiotherapists. How efficacious? I don’t know because I made the numbers in the example up, but one thing is for sure; it stands to reason that it is EVEN MORE EFFICACIOUS THEN WHAT THE RESEARCH SAYS.
So that’s the quicksand. It’s quicksand because these so-called sceptics (they are nothing of the sort) use the research argument to point at efficacy or lack thereof. I have always stood by the argument that there is no research available which would allow anyone to draw conclusions about the efficacy of spinal manipulative care, let alone chiropractic care. That’s of course not a good thing, but it is what it is and it certainly does not allow for these muppets to draw the conclusions they are drawing.
But! and this is where some introspection is fair point to balance the argument: chiropractors have been muppets for making claims they couldn’t make (as there is no good quality evidence “for” either), chiropractors have been muppets for being tacky, unprofessional and unrepresentative and have in consequence created ammunition for the other set of muppets to scoop up, embellish and throw at us. So,… and this is where some appreciation of the intricacies of the human mind comes in handy: can I blame these sceptics for being so dim-witted? No, not really, firstly most of them have no idea of what clinical life is like, have no or very limited understanding of anatomy, physiology, pathology etc. and are wrapped up in the world of stata or html code (or both). It’s a version of reality they are comfortable with and they are doing what we all do when we are comfortable, … become complacent and believe our own male bovine excrement.But that said, I am grateful to them (in a philosophical humanist kindaway) for putting the profession in disarray and maybe this will mean we are going to clean this gig up. I will do my best, I hope you will do too.
As they say on twitter: #epicfail
This is only the beginning
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