Chiropractic evidence: The curious case of the missing study

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silhouette200As many of you may know, my mate Simon Singh is currently being sued for libel by the British Chiropractic Association. Chris French has recently put a great summary of the issues in the Guardian, and I would urge you to support Simon’s campaign for freedom of speech in science.

Aspects of the case revolve around the evidence (or lack of it) for the chiropractic treatment of children with colic. Although there is some anecdotal support for this notion, in my opinion such stories would not cut the mustard in the scientific arena (as the gag goes, the plural of anecdote is not evidence). After all, mothers may be give an inaccurate report of their children’s behaviour, or may have sought out treatment when the condition was especially bad and thus any effect could simply due to the symptoms becoming less severe over time.

That’s why controlled studies are so important. In my opinion, the only decent study to date was carried out by Olafsdottir and colleagues in 2001. Unlike the handful of other experiments into the topic, this study used proper blind procedures and controls, with, for example, the mothers involved not knowing whether their child was receiving chiropractic treatment or simply being held. The results showed that chiropractic spinal manipulation was no more effective than the placebo condition. I am not the only one to think that this is a vital study. For example, a 2002 review of chiropractic treatment for infant colic in the Archives of Disease in Childhood (here) only cited 4 studies – one of which was the Olafsdottir experiment, which was singled out for its sound methodology.

Yesterday I put in the search terms ‘chiropractic research infant colic’ into Google, and looked at the chiropractic sites that offer evidence about the efficacy of the chiropractic treatment for infant colic. I couldn’t find one that described the Olafsdottir study.

Of course, it is up to them which evidence they list, but I would have thought that a major study like that deserved a mention somewhere. Am I missing something? Can you find one?

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55 comments on “Chiropractic evidence: The curious case of the missing study

  1. Nick says:

    I’m going to stick my neck out and say they probably excluded the study because its conclusions were unfavourable. To be fair, though, they may have rationalised their exclusion by noting that the study’s methodology included proper controls, thereby suppressing straight chiropractic’s mode of operation.

  2. Nick Sharratt says:

    Is this all a side effect of medical treatment being non-free? Eg any one who is driven by the motive of proffit will select evidence to present their product in the best light to prospective suckers *cough* sorry, patients.

    Since some legitimate/recognized/evidenced medical treatments need to be paid for, we validate the notion of people proffiting from others suffering/need and hence bogus treatments proliforate and to survive they need good marketing so apply selective evidence.

    (I’m not picking out any particular ‘medical’ fields for critisism)

    should any treatments not independantly verified for efficacy and risk/cost be ‘banned’ or at least required to carry very strong and prominant warning? Eg “this is not an effective treatment for any medical condition and is provided for entertainment and emotional comfort purposes only”

    …or am I being a little too harsh?

  3. Shig says:

    Was it a chiropractor or an accupuncturist who, on hearing the results of a study, said, “This is why we don’t do blind studies?”

  4. Nick says:

    Shig, maybe it was a homeopath.

    In 2005, Paula Ross of the Society of Homeopaths wrote: “It has been established beyond doubt and accepted by many researchers, that the placebo-controlled randomised controlled trial (RCT) is not a fitting research tool with which to test homeopathy.”
    Letter to the Guardian, 26th August, 2005.
    http://bit.ly/nkMKo [Word document]

  5. Richard King says:

    Is the link given for the British Chiropractic Association, actually the Scottish Borders Donkey Sanctuary, an error, or indicative of the standard of debate.

    I have not read the study “by Olafsdottir and colleagues in 2001”; will have to get it via a free regristration when I have time later today.
    If the Chiropractors are being selective in which studies they choose, I am wondering how that is different from Simon Singh and Edzard Ernst being selective in their book “Trick or Treatment”, which had a reading list at the end but no references at all. Unlike books on CAM and related subjects by Daniel Benor and Lawrence LeShan which have many.

    I have yet to see any evidence for Simon Singh’s contentions either.

    I am not siding with the Chiropractors but there are obvious failings on Simon Singh’s side.

    If science is to be above the law it is intriguing to speculate what those of us who are more than scientists could get away with; science is only a small part of engineering and knowing something about the law, along with myriad other things admittedly, is part of what we have to learn in addition to science, as well as begin precise with experimentation, words etc.

    Science, or what passes for science these days, seems to have become rather selective, in the subjective rather than objective, sense since I began learning it in the 1950s.

    • uksceptic says:

      No one is asking for science to be above the law. This is not what the case is about at all.

      What we are fighting for is to keep libel out of science. If someone criticises your methods or questions your evidence you can’t just go around suing them. You should stand on the weight of your evidence not the power of your lawyers.

      You keep saying science is subjective yet it is the ‘science’ of the alternative medicine and psychics that is selective/subjective not that of Simon Singh and Edzard Ernst who you keep citing.

    • Richard King says:

      As I have written elsewhere, the problem with Simon Singh’s comments was that were considered legally actionable; going by the definitions of the word “bogus” I have to agree. Simon Singh could easily have found the words to criticise to the almost same extent, just stop short of those that imply, or say directly, that people are being deliberately dishonest, unless, of course, he has the proof that they have been. He could also have withdrawn the word that implied, or stated, dishonesty, let the rest of his case stand and, ideally, publish his own evidence; I am aware that there seems to be some dispute as to whether he was given the chance but he could have done that anyway.

      By keeping libel out of science, that does seem to be trying to put science above the law. Anyone who cannot put the point, make criticism, without going that far is not much good as a scientist, or in many other respects. If “You should stand on the weight of your evidence … “, where is Simon Singh’s evidence against the chiropractors? For that matter where is the evidence to back up the repeated use of the word “lies” in “Trick or Treatment”? Even the title of the book implies dishonesty.

      In any case, overall there does seem to be an element of “I hit them and they hit me back; hitting me back is not fair.” If you have a go at someone, or a group of people, it seems only reasonable to be man enough to accept the consequences. The follow up of wanting libel not to be part of scientific disputes comes across as special pleading. It is not difficult to make comments to the extent that one has evidence to substantiate those comments and is really what science is supposed to be about. Anyone who cannot mange that is either not a scientist or not much of one.

      Besides, as I understand it and have read across the Blogs, Simon Singh seems not to have meant the dictionary, or legal, interpretation of the word, “bogus”.

      Several years ago I was “turned over”, “ripped off” by a corrupt Council (it is on the Internet) and barely survived, financially(http://richardking.blogspot.com/2008/02/news-blackouts-princes-and-kings.html). During those difficult years I did not take as much notice as I should have done, otherwise would have done, as regards documentation connected with a certain event. Years later I learned that, in relation to myself, it had been entered on a Probate Form that I had declared no interest, though I had not been consulted and knew nothing of it. My reaction, thoughts, was that what had been done constituted fraud. I checked the meaning of the word in dictionaries and Online, particularly the legal definition. I concluded that I was probably correct in my interpretation but there seemed to be a caveat in the legal definition relating to intent. As member of East Hampshire Chamber of Commerce, by default also a member of Portsmouth and Southeast Hampshire Chamber of Commerce, plus Southern Entrepreneurs, etc., I meet many business professionals including legal ones. Essentially, all but an office junior agreed it was fraud; heading up to a hundred to one of that general view. Most importantly a probate specialist said it was definitely fraud, quite capable of being taken to court but no further unless there was material gain, though I am sure there was not. The point being that I habitually check definitions carefully and, when it is important, take great care. I am not infallible but it is exceptionally unlikely I would have made the definition error that Simon Singh did. Partly that is due to personal preference and habit, partly because of my engineering background, especially having been in aerospace. That is not an industry for sloppiness, either in definitions, or anything else, though much the same goes for engineering generally; people’s lives often depend on definitions. I cannot imagine anyone like Simon Singh making it as an engineer.

      I did not say science was subjective; what I did say, as I recall, was that scientists are often subjective. Science as a whole can be considered subjective at the higher reaches of science and other matters but that is too deep for here and now.

      For example, Singh and Ernst’s assertion in “Trick or Treatment?” that energies sensed and channeled by healer’s are implausible. That is a subjective judgment. There are things that scientists found implausible which have come to pass and many that are proposed, propounded by scientists that other people find implausible. Besides, as there is no definition of energy and no-one knows what energy is, neither Ernst, Singh, nor anyone else is in much of a position to pronounce on implausibility relating to energy.

      To very many of us it is entirely plausible; we routinely sense it and use it. For all practical purposes I can approach anyone and know that I can feel there non-physical components as easily as I can there physical body; admittedly it involves a slight shift in consciousness but, after almost two decades, that is second nature and close to instantaneous.
      Similarly with the hackneyed “Extraordinary claims require extraordinary evidence; that is subjective. Again, to very many of us there are matters that mainstreamers tend to find extraordinary and we find very ordinary. Besides, science is not the only way of gaining knowledge, nor, necessarily the best way and cannot be proved to be either without using something better to prove it, a contradiction in terms, or using science to do so, a circular argument which is untenable.

      However, a great deal of science is subjective, of necessity.

      A while ago I was given a copy of a booklet on mental health. Among other things it explained that, whereas physical medicine is 99% objective and culturally independent, mental health medicine is over 90% subjective and culturally dependent. I was already, broadly, aware of that, having studied psychology during my Degree course (Brunel University, 1967-1971) compulsory for all engineers in the first year, my choice as a Liberal Studies subject in years two and three. I am not a psychologist but I do know a fair amount about the subject. Ideally, in experiments, you take as much of the subjectivity as possible out of it. Hence my view that the Patricia Putt experiments and the “remote viewing” experiments, described on this Blog, were low grade; both could have been made more objective, the Patricia Putt experiment with relative ease, the “remote viewing” experiment not being remote viewing anyway. Remote viewing is for sensitives and is structured; the “experiment” carried out was an exercise related to telepathy carried out at a relatively low level, in the standard of science sense; I am afraid what came to mind, with me, was BBC “Blue Peter” level. Even so the experiment could have been far better, though I am not sure that the intention was for anything more than “pop science”, even if New Scientist does put an interpretation on the results far above anything that could be justified by a real science approach.

      Science applied to Complementary and Alternative Medicine, as well as “psychic” matters, can be objective, or more objective than it is. Strangely, it seems to be the mainstreamers who enter those fields who perform the poorest experiments. For example, the experiments Edzard Ernst carried out with Spiritual Healers, completely missing ruling out an obvious variable, at least obvious to a Healer who knows science, though all of the healers in my Group saw the problem immediately when I described what had been done; two of us have a science background, Sue and myself; Sue is a fellow Member of the Scientific and Medical Network, has run a pathology laboratory, among other things and recently gained her full “Healer Member” membership of the National Federation of Spiritual Healers. There was also another matter he field to take into account. Added to that is the page on Spiritual Healing in “Trick or Treatment?”, which he co-authored with Simon Singh; the definition is wrong, the descriptions are wrong; a dozen or so errors in one page. Edzard Ernst is Professor of Complementary Medicine, has experimented in the field of Spiritual healing, has pronounced on it as a result but has not a clue what is involved or what he is talking about. For someone who has been a Professor covering such subjects for fifteen years, or more, that is a phenomenal and extremely perverse achievement; broadly equivalent to a professor of mechanical engineering being completely clueless about metallurgy but pronouncing on it nevertheless.

  6. Bob says:

    I think it sounds quite similar to the ‘psychics’ commenting on the post about the twitter experiment. It’s possibly the same mindset, they accept all ‘good’ evidence and reject all the contradictory evidence. If they haven’t been proved right they believe that the experiment was poorly devised or that scientists are out to get them. Good old fashioned confirmation bias.

  7. Lafayette says:

    I don’t suppose this study appeared in the plethora of evidence the BCA submitted? It seems unlikely that an organisation as professional as the BCA would not know of its existence. If it’s that robust a study, and the BCA don’t acknowledge it, wouldn’t that suggest… oh, never mind…

  8. Goldfysh says:

    I expect they excluded it deliberately, we can only speculate as to why. I find it interesting that so many (I assume) ‘sceptics’ commenting seem to assume some wrong doing on the part of the BCA rather than considering alternatives. It may be that the BCA have looked at the study and find its methodology to be a problem, hence their exclusion. It may be that they are assuming it is inaccurate/worthless because it contradicts a multitide of other studies (quoted on their site) and their own experience.

    After many years of experience with complementary therapists I have yet to meet one who fits the sceptical stereotype of snake oil salesman. The worst I have encountered is well meaning but misguided people, with one exception where a gentleman had let his ego get out of control. I have however met many well trained, informed and caring individuals who genuinely believe they are helping. These are not the type of people who would intentionally mislead for profit.

  9. Soapy Sam says:

    Tend to agree with Goldfysh that Chiropractors are apt to be no more or less wilfully dishonest than any “therapist”, CAM or mainstream. I only ever met one and he seemed as straight as a die.
    Many GPs are financially motivated- why should they not be? Some have not hesitated at murder for financial gain. This doesn’t mean they are all psychopaths, cheats, or liars. It is highly improbable that all chiropractors are either. What matters is whether or not they have their facts straight.
    The questions here are twofold- can chiropractic back up its claims with solid evidence and should / can the UK libel law be modified to prevent disputes about facts degenerating into squabbles over legal technicalities to be judged by people unfamiliar with the morals or facts on either side.

    I suspect many chiropractors regret this mess as much as the sceptics – and probably agree about the inadequacy of libel law to answer the relevant questions.

    Those of us on the sceptical side are pleased at the response to Simon’s dilemma. We are feeling proud of ourselves and perhaps just a touch smug. Perhaps we have some reason, but let’s not overdo it. This is not a witch-hunt . It’s an issue about fact and a criticism of law. Let’s hold down the self-righteous glee.

  10. dvnutrix says:

    The BCA neglected to include a number of relevant papers when discussing the evidence to support chiropractice interventions in children with non-musculo-skeletal conditions.

    Gimpy’s discussion on the evidence around chiropractic for ear infections

    Gaylard on Chiropractic as a treatment for bedwetting

    David Colquhoun reviews the papers on colic presented by the BCA and notices the gaping hole where Olafsdottir should be.

    Evidence Matter’s British Chiropractic Association and the Plethora of Evidence for Paediatric Asthma identifies major, high-quality trials (with negative outcomes) that the BCA didn’t mention, even though the authors included chiropractors.

  11. uksceptic says:

    I think Simon made a great point on the Skeptics Guide about how when you criticise someone’s method of treatment you hope as a sceptic and scientist this opens debate and you would expect them to come out with evidence to support their claims. However instead of doing this they sued him for libellous and are yet to provide any evidence in support of their claims that they can cure/alleviate a host of complaints.

    This speaks volumes about the type of organisation the BCA are.

  12. Bob says:

    Even if chiropractors believe what they are doing is right, surely the person that taught them, or someone somewhere, must take the responsibility for the efficacy and safety of their ‘treatment’.

  13. Nick Sharratt says:

    To quickly clarify my earlier point-I didn’t intend to infer individual practitioners motivated by profit are the problem-I was thinking of a proffesional body which needs to oversee the science/research, that needs to have a detatchment from any vested interest. It seems in this instance that there could be a conflict between examining the science and being the body that also supports the businesses. Perhaps the two roles need separating to avoid conflict – and not just in ‘alternative medicine’ either.

  14. JJM says:

    Concerning the possibility that the BCA found the negative study flawed or outweighed- that is nonsense. http://www.ministryoftruth.me.uk/2009/06/18/examining-the-bcas-plethora-of-evidence/ Or, maybe not since chiropractors have little knowledge of health care and how to study it.

    The chiro studies favoring treatment of colic are all flawed by some combination of: too small, un-controlled, improperly controlled, un-blinded. All the “positive” study results are consistent with spontaneous recovery; which is what happens with colic.

  15. Victor Meldrew says:

    Always up for a challenge I found this site:

    http://www.chiropractic.co.za/index.html?lf=1;pg=21;ai=211 which does list the paper by Olafsdottir et al in its references.

    What is shameful is that the editorial leads the reader to believe that chiropractice is beneficial in treating infantile colic, and makes no mention of the Olafsdottir findings.

    • Richard Wiseman says:

      Well done! That site is also odd though. They ref 5 studies at the end, including the Olafsdottir one. However, only the other 4 are cited in the main text.

  16. Joel Saeks says:

    Question, can a true randomized controlled study be done on humans? No! No two humans are identical except genetic twins and even then their lifestyle can make changes, which means there are multiple factors unaccounted for genetics, nutrition, parental care, etc. In Medicine a true randomized controlled study is done using genetically identical mice to rule out any random problems that might be caused by non identical mice. There was a case in the 80’s where a cancer study had to be scrubbed due to impurities within the genes of the mice (they were not identical). No two back pains are identical and no two cases of colic are identical unless it is the same person. So antidotal evidence is all we have. Just as in psychology which therapy is truly effective or the fact that many drugs are used that they have no idea how they work and that they work differently in every different person. To me the proof is in the pudding as they say. If it helps a patient get better does it really matter how.

    • Jeremy says:

      Joel Saek, you need to spend a bit of time studying statistics – it’s essential for a proper understanding of the scientific process. Of course no two cases are identical (even in the same person!), which is why you need a large enough sample to flatten out all the noise and get a statistically meaningful result.
      Anecdotal (not ‘antidotal’) evidence is not evidence at all when it comes to medical science – there are far too many ways for confounding factors and bias to skew the results. Anything short of a double-blind, randomized controlled trial is just useless.
      In my experience, far more people tend to BELIEVE they have critical thinking skills than actually do.

    • Carmenego says:

      Right on Jeremy!

      “If it helps a patient get better does it really matter how.”

      Yes, actually, it does, which is why RCTs are essential for treatment of certain problems. You don’t have to do a lot of reading to find out that we’d still be advocating bloodletting or trepanning to cure our ills if we didn’t use RCTs. We wouldn’t realise the dangers of smoking or drinking, or eating too much pork!

      Some people get really ill. By falsely asserting that you can cure them by any means other than *properly* tried and tested methods is patronising, emotionally exhausting, (potentially) expensive and absolutely immoral, as they exploit people who just want to get better by the best means possible.

      It’s attitudes like that that prevent people getting access to something proven to work which *will* make them better as opposed to something that may or may not, but hey what’s the harm?

      Go and read Trick or Treatment – get it out of your local library if you’d rather not pay to have your views challenged, or take a look at a few of the many blogs online discussing this:

      http://richardwilsonauthor.wordpress.com/2009/06/14/chiropractic-treatment-found-to-be-ineffective-against-panic-and-jitteriness/

      http://www.dcscience.net/?p=241

      http://layscience.net/node/566

      http://whatstheharm.net/chiropractic.html

      I could go on.

      Grrr.

    • uksceptic says:

      Well said Carmenego!

  17. Lafayette says:

    Joel,

    That’s why we like big sample sizes, because it’s the best way we have of dampening out all that noise.

  18. Phil says:

    You might find it a bit difficult accessing UK chiropractic websites. Due to some sterling work by skeptic bloggers like Adventures in Nonsense, the McTimoney Chiropractic Association has been advising its members to take down their websites or face litigation for making unsubstantiated claims about the benefits of their services.

  19. Sally says:

    I checked the American Chiropractic Association’s Council on Chiropractic Pediatrics website. Under “colic”, there are three studies listed: all of which show the benefits of using chiropractic techniques.
    Not sure if related, but this reminds me of:
    A few years ago, my mother had some medical issues with what was vaguely described as rheumatoid arthritis. She went to a number of doctors to try to pin-point the problem (to determine whether in fact it was actually rheumatoid arthritis). The rheumatoid arthritis experts insisted that she did indeed have the disease, and put her on drugs that were supposed to help. She continued to feel lousy. After researching, I found that the drugs were documented to often create similar symptoms as the disease! I talked my mother out of taking the drugs, and her symptoms went away. (possibly due to passage of time?)
    Throughout all of this, it seemed pretty clear that the rheumatoid arthritis experts were pushing the rheumatoid arthritis diagnosis: no other options, no other possibilities, no other way of looking at it.

  20. Jon C DC says:

    As a Practicing Chiropractor I find myself frustrated by the quality of the remarks by those who consider themselves sceptical. A questioning mind is healthy and had it not been so I would not be practicing as a chiropractor now.

    Having completed a degree in Biomedical Sciences prior to commencing a 5 year degree in Chiropractic, I like many other scientific minds continue to understand the importance of the scientific method, having written a number of experimentally based dissertations myself. Having the ability to demonstrate, through well defined research the efficacy of your subject matter has a truly beneficial part to play in the advancement of science as a whole. However, it is only a part, and like many other approaches carries its own flaws. Chiefly among these is the vested interest of the party funding research studies.

    Sadly, we do not live in an ideological scientific world. If we did the truth, true scientists aspire to would not be capped, cut off or partially published by financially driven enterprises that seek only to provide results which further their particular interests. As any practicing scientist will tell you this tends to be the greatest bug bear when submitting research proposals. Whether we like it or not, research is an expensive business, and if your particular research is not likely to line the pockets of those funding you it is simply not likely to happen.

    But what about the scientific method! Well it doesn’t apply to medicine so why insist it apply to us! How many untried and untested surgeries are carried out everyday without a shred of evidence to support them. When we do have the evidence, examine it! Spinal fusions or laminectomys carry an 80% FAILURE rate, with either no change or worsening of presurgical symptoms, set aside the risks associated with surgery itself and anaesthesia. Create hypothesis, test hypothesis Chemical A + Chemical B = Chemical C repeat and get the same results for eternity. That’s the scientific method. Give 10 people with a headache an aspirin and sit back and watch the diversity! Replace aspirin with any drug, surgery or physical intervention the results will always be different because of the 1000’s of variables which make up the human bodily functions. RCT’s, statistics, P values of course can be manipulated to say whatever the financial backer wants them to say. What about advertising standards? Have we all seen the advert for the painkiller that targets the site of the pain! Now how does it do that, does it have a little brain! Oh well, everyone knows its just marketing and it really blankets everything. That’s ok then! How do they get away with it? Money! Money! Money! What about the safety issue with Chiropractic. Sinister risks with chiropractic are incredibly rare with incidences suggested at 1 in 500,000 to 1 in 3million. In perspective iatrogenic death (or death caused by or resulting from medical intervention or advice) is now estimated as the third highest cause of death in the US.

    Why I mention this is two fold. Firstly there are only 2 ECCE (European Council on Chiropractic Education) accredited Chiropractic schools in the UK. Primarily research is carried out at the University level. Here each school has approximately 300 students per year all of whom are required by statutory regulation to carry out a research dissertation as either an experimental study, or a literature review. Sadly although excellent and compelling work is produced, as is the case in the hundreds of universities across the land very few are published and therefore cannot qualify as recognisable research. Mine for example studied the effect of chiropractic adjustments of the cervical and upper thoracic spine upon patients’ hearing. The hypothesis setting out to either confirm or question DD Palmers original finding of restoring Harvey Lillards hearing. My test subjects were patients receiving chiropractic care at our teaching clinic. Every patient tested via recognised audiometric testing had no diagnosed hearing complaint. My findings showed that a significant number of patients had markedly improved hearing following an adjustment. This was in comparison to my control group that only received chiropractic adjustments below the level of T4. This group showed little or no change post adjustment. In addition a follow up study showed that this improvement had sustained at their next scheduled appointment.

    Although I followed the scientific method and provided reproducible results, having not had my findings published in a peer reviewed journal they are inadmissible to the current available research. Of course, my failing was to submit my findings, however how many students across the land submit quality research which never finds its place in a periodical. Sadly, just as doctors attend medical school to help maintain and restore life, Chiropractors attend college to help improve, maintain health and potentially prevent future problems. Neither attending college to become research scientists. Luckily for medics there is an entire infrastructure dedicated to medical research, not so for chiropractic.

    Here lies the flaw. According to UCAS there are currently 325 Institutions in the country providing degree level studies. My Biomedical Sciences year had 200 students alone. Examining studies funded for medical or scientific research often find their beneficiaries in the lucrative pharmaceutical industries. This is in itself not a bad thing. It off course allows for the continuing advances in medicine that allow for wondrous interventions when critically needed.

    Therefore of the 325 Institutions there are thousands of students and scientists creating, experimenting and publishing many thousands of articles, which helps expand our medical knowledge and generates further study.

    Examine chiropractic research in comparison, still as costly but as can be seen from the sceptics still as important. Now question where this research in the vast quantities requested is to come from. Whether believed or not, Chiropractic has been seen to help many different age groups with a host of different complaints, using a natural, non-invasive technique that does not require the prescription of any pharmaceutical. Are these companies likely to bend over backwards to fund the research. Sadly and unsurprisingly not. Equally are there hundreds of universities throughout the land with large Chiropractically interested students writing, and publishing chiropractic research. Again sadly not. What research exists, currently sits unpublished on chiropractic library shelves. Is this anyone else’s fault. Off course not. Just because these copious studies are not published doesn’t mean chiropractic does not work it simply means we as a profession need to work harder at publishing.
    I am not intending to make excuses for our weaknesses as a profession but suggest that even with our failings chiropractic continues to help and improve the quality of life of many thousands of well educated patients who attend our clinics daily despite limited research.

    In addition, many sceptic bloggers make the claim that chiropractic targets the weak and vulnerable.

    Although one of my biggest complaints by patients is that chiropractic care, as a private health care, can be expensive and is (until recently via the NICE guidelines) unavailable on the NHS and is therefore appearingly unattainable by the aforementioned weak and vulnerable it certainly insinuates that chiropractic patients simply do not have the intelligence to make an informed decision and are somehow being manipulated into starting care.

    This could not be further from the truth. Ironically the vast majority of patients attending our clinics for their initial consultation carry with them equally sceptical minds, filled with articles such as these as well as the preconceptions of their friends and families, having often exhausted all other avenues. In fact they are basically primed not to believe a word we say. Nevertheless If chiropractic is found to be a course of action that might benefit the patient, full explanations are given and treatment, with consent begins. There is no talk of mysticism as some bloggers may have you believe, just a simple straight forward explanation as to how our bodies and our nervous systems function in relation to the presenting complaints. If of course chiropractic is not a viable course of action, our training in diagnosis enables us to make the relevant referral with the correct expediency.

    Among my patient base alone I have Nurses, Midwives, GP’s, Consultants, Lawyers, Service men and women, Lecturers, Managing Directors and Professors. Not classically thought of as ‘weak and vulnerable’. Further still, these same individuals not only have achieved relief from their symptoms they have chosen to continue to maintain these improvements, in most cases, over years. Do I go to their houses and drag them into my clinic each month, do I hound them with marketing material until they relent. No. patients choose what is best for them. Do they consider being labelled weak and vulnerable, worse still ‘brainwashed’ by a small minority offensive. Of course.

    Naturally, journalists and scientists are supposed to present the news and results in an unbiased fashion. But then that wouldn’t sell! Ask us to work harder as a profession to solidify our foundation of research and subscribe to the recognised standards but please do not insult the integrity and intelligence of our patients along the way

    Finally I am often asked whether I agree with the BCA’s approach to the case with Simon Singh. As a scientific journalist it is absolutely fundamental that Simon should question the validity and efficacy of any therapeutic intervention, including, of course, chiropractic. Not to do so would not advance scientific knowledge. However to label something as ‘bogus’ simply through limited investigation overstepped the professional mark. Doing so allowed him to join the ranks of fellow eminent scientists who vilified anyone who suggested the earth was round and that we were not the centre of the universe! His support is admirable, but personally I feel once further study is completed and evidence comes to light that indeed chiropractic does help those suffering many different complaints, he may have benefited from saying that ‘although there is a lack of compelling evidence to the standard required by our current western medicine, although anecdotal, it appears chiropractic may have, a currently poorly understood effect on a number of conditions, however I will continue to have reservations until a better quality of investigation is carried out.’ His choice of language is what has infuriated many within the profession, and has led to the situation being what it is. Is it ideal, no! could the money have been better spent on research? yes. But defending oneself against such comments is not just to protect chiropractic but also the many educated and infuriated patients who both benefit from and will continue to benefit from chiropractic care.

    • Richard Wiseman says:

      Thanks for that and nice to have you here. But to get back to my point – any idea why that important study is missing from all of the chiropractic research pages that i could find?

    • Richard King says:

      In other words, never mind all the good points and tight reasoning brought up by John C DC, worry the bone to death, regardless.

      As yet I have not had the time, between clients, etc., to download the relevant study, let alone read through it properly. Though the chiropractors not referring to it could be for a myriad of reasons, perhaps completely different to the reasons mainstream scientists and self styled sceptics ignore studies when it suits them, maybe for other reasons. For example, on page 327 of “Trick or Treatment”, a single page on my own modality of Spiritual Healing, “Many clinical trials of various healing techniques are available. Some initially generated encouraging results, but about twenty of these studies are now suspected to be fraudulent.” with no reasoning given other than “suspected” and no reference to obvious sources such as “Healing Research Volume 1, Spiritual Healing”, by Daniel J. Benor, MD, with over a hundred pages of Appendices, Endnotes, Glossary and Bibliography (a list of References). Admittedly there was only one page on Spiritual Healing, though it managed to contain a dozen or so errors, indicating the authors to be completely clueless on the subject, though it did not stop Edzard Ernst conducting experiments, with a very obvious flaw, at least obvious if you understand what is involved.

      I have not particular reason to support the chiropractors other than contributing to research from an understanding of both sides, certainly in my own area, and trying to bring good science to bear, obviously lacking at present.

    • uksceptic says:

      Thanks for your comments Jon. However I can’t help feeling that if there is this wealth of evidence sat on the shelves of Chiropractic institutions why the BCA didn’t attack Simon Singh on his science rather than suing him for libelous?

      We have no proof that all this evidence exists other than to take your word for it, you talk about studies that you and others have conducted but again you just want us to take your word for it.

      Complaining about pharmaceutical companies is also kind of missing the point. No one here is claiming these institutions are flawless but to say look how bad they are, we aren’t that bad, as a defense to chiropractic medicine is a bit of a weak argument.

  21. Soapy Sam says:

    One might hazard a guess that the reason is the same Ben Goldacre points out in his book “Bad Science”. Chiropractors , just like Pharmaceutical Company managers, are under pressure to sell.
    This surprises nobody. What matters is whether what they sell works.

    That spinal manipulation can correct problems of musculo skeletal misalignment due to injury or poor posture seems eminently reasonable, though some woyuld argue less drastic physiotherapy or simple exercise may have similar effects. This is why we need data.
    That it might cure colic in infants seems. prima facie far less probable.

    If, as Jon C DC says there is a wealth of useful evidence sitting on college shelves, it is all the more sad that the research produced by the BCA should be so pathetically lacklustre.

    Chiropractic taken as a whole is no small business, though the individual operators may be. Gross turnover in the UK alone must run to many millions. It is sad indeed if the professional bodies responsible have failed to divert some percentage of this to publishing fundamental research.

    There is indeed much anecdotal evidence that chiropractic can help some patients but so long as it remains uncollated anecdote, it will remain worthless. Evidence based medicine must be the shape of the future and this applies to every aspect of therapy, “mainstream” and “CAM”.

    Jon- we should indeed be just as sceptical about many aspects of mainstream medicine if the evidence is inadequate.
    Yes, many sceptics feel Simon’s choice of words might have been better, but an exchange of letters in a public place might have settled the matter with a small climbdown from the extreme claims on either side.
    Suing for libel (and Mr. Justice Eady’s bizarre ruling ) turned this into a scientific freedom of speech issue, over which sceptics (and I think you count yourself such), do tend to start venting steam from the ears.
    That has changed the issue from one of demanding a far higher standard of evidence from the chiropractic industry to an issue of scientific freedom. If people get rather more excitable in that case, well , sceptics are human too.

  22. Greg Stevens says:

    Reading all of the science entries on this page, I am surprised that the question of the BCA leaving out the olafsdottir study has not been answered! The study is not relevant to the case. To remind you there was not a jot of evidence was a problem use of words. Why then in a defense of this statement would one even consider putting forward a study such as olafsdottir et al? The BCA are not underhand, nor stupid…

    Great post by Jon C. The research money is what governs what gets reserached not the efficacy of the unresearched treatment – cause it is not known I hear you say! Science begins with a hunch (from the ‘in’ crowd). For those unsure about this then please look up Marcia Angel’s book as a start. She was the editor in chief of the New England Journal of Medicine for 14 years and has come out the other side to spread the word. P.S. the NEJM is the number one medical journal in the world! Through this book and others like it the general public can realise that Chiropractors are nothing like Pharmaceutical managers ‘under pressure to sell..’

    What is NICE to see are the new Guidelines (did you see what I did there?) and what is even better is the MRC are looking for good quality trials to show differences in CAM, to show cost effectiveness in CAM. (At Last, but only this year!)

    As an outside minority community Chiropractors have been through jail and 25 year conspiracy from the medical establishment (Wilk Trials). Perhaps once we had gotten ourselves out of jail, proven the work of the AMA against Chiropractors, in court, set up legislation in the UK, set up through our own expense a governing body that simply just costs Chiropractors more to be a Chiropractor in the UK, to have gained exceptance in two universities in the UK, with feasibility studys being carried out at more Universities in the UK; is it any wonder that the profession of c.3000 (doubled in the last 10 years) with no central funding does not have much in the way of high quality trials? Really sadening when an eminent professor (definition of an eminent professor is standing in the way of change!) post ridiculing articles about Florida State University considering a Chiropractic Programme, that same professor in another article uses 80+ year old evidence to substantitate the Chiropractic profession in New Zealand. Not cricket! When another equally eminent professor from further SW England generates a very recent article about Chiropractic maintenance care (in a journal), when it has already been a regular practice for rheumatology consultants to regularly see RA patients – for no other reason than they know regular visits improve outcomes for the patients. It is right for consultants to do this but not for Chiropractors..?

    Look at the trend of the direction of the profession and you will notice Chiropractors are keen to show when given the chance that ‘it works’.

    Let us not forget that medication when packaged as different colours has different effects in different countries, even when the same dose. Injections have differing effects to tablets even when dose controlled. Where are the studies that have been done on all medicines in all colours in all guises?? Because if the medicine is the same why the within population differences in research? Well if we waited to have science to back up what we do all of the time – we would have nothing.

    It is work in practice…

  23. Jackybird says:

    The problem of funding for scientific research is real, but its existence shouldn’t be used as a smokescreen to justify unproven treatments. Why don’t you start a non-profit foundation to do quality studies of areas which are underfunded because they don’t have the potential to yeild profits? An organization like that would surely do a lot of good.

  24. Greg Stevens says:

    You mean like the FCER? A non-profit foundation that Chiropractors contribute out of their own pockets to every year to fund research projects.

    ?Que passe smoke screen?

  25. […] Chiropractic evidence: The curious case of the missing study As many of you may know, my mate Simon Singh is currently being sued for libel by the British Chiropractic Association. […] […]

  26. Ed Darrell says:

    You know, in the U.S. we require pharmaceutical companies to list the major contradictory studies and known side effects as well as the stuff that supports their case. Ethics for physicians requires that they inform patients of the problems of procedures and the accurate evidence for whether it will work or not.

    Those are ethical baselines.

    The baselines help the physicians and pharmacists keep their own perspective on what works and what doesn’t work.

    Is there any evidence that ignoring the contradictory studies and evidence either improves patient outcomes, or chiropractic practice in Britain? I find it difficult to believe that BCA has a completely different scientific method and set of ethics.

  27. uksceptic says:

    It is very hard to sympathise with a lack of funding for studies into Chiropractic medicine when the BCA are currently spending a large sum of money suing someone that questioned chiropractic medicine’s ability to cure asthma, colic and ear infections.

    Why don’t they use that money to fund an impartial organisation to conduct a study?

    I don’t think this issue has been met by any of the Chiropractors posting on here at all. None of you have answered Richard’s initial point about why your various organisations fail to mention the Olafsdottir study, instead you complain about the lack of studies done. Or is it that you are really complaining about the lack of controlled studies that support your questionable claims?

    Ignoring the evidence and arguing completely irrelevant and alternate points, attacking the source of the argument rather than the argument itself and changing the subject to attack other professions. These are the actions that we are used to seeing from homeopaths, creationalists and cults and now these are the actions we are seeing from chiropractors.

  28. […] June 25, 2009 I have been taking part in a debate recently on Richard Wiseman’s blog after his post Chiropractic evidence: The curious case of the missing study. […]

  29. […] (See also Richard Wiseman’s blog on “the missing study”) […]

  30. Soapy Sam says:

    There is only one appropriate defense against the charge of lacking evidence; to produce evidence.

    The same charge could be- and in recent years is being brought against medicine in general, but it seems reasonable to start at the fringes and work in.

    It also seems possible that if people start demanding evidence in medicine, whether of chiropractors or proctologists, they may start demanding it of politicians , journalists- oh, all sorts of folk; possibly even of Senior Judges.

    Wouldn’t that be a turn up for the books?

  31. Lady Crafthole says:

    There once was a man named Singh,
    Who said some very sensible things:
    ‘Chiropracty’s bad science’,
    The CBA sued in defiance,
    Now we’re desperately hoping he wins.

  32. […] Chiropractic evidence: The curious case of the missing study […]

  33. Rufus says:

    Throughout this comment trail we have one side saying “anecdotal evidence is not evidence” and the other side saying “Results are results” so I thought I would throw in an example from the real world of why anecdotal evidence is not evidence.

    There used to be a confidence trick (it almost certainly still exists) that worked as follows:
    People who wished to choose the gender of their baby would be given a course of injections (originally a does of oral medication but everything moves with the times). At the end of the series of injections they would discover the gender of their baby. If the gender was not what they requested their money was returned under the no quibble guarantee.

    The treatment was backed up by a lot of evidence. First and foremost was the anecdotal evidence, testimonials from thousands of happy couples. Of these some had used them multiple times with great success. You could not really knock the treatment; the proof was real living human beings. Next there was the statistics. The people offering the treatment opened their books and collated their customers’ successes vs. failures. A huge percentage of their customers were successful, well above 90%. This clearly isn’t an RCT but it is compelling evidence.

    So given all of this how can I say it was a confidence trick? Simple really: the injections were a saline solution having no effect whatsoever.

    So where did all this evidence come from? Well there is approximately a 50% chance of either gender, so around half the people treated were happy customers. Being happy cusotmers they sometimes returned. Most didn’t return having only felt the need to ensure the gender under extreme circumstances and being happy once they had a child of their chosen gender, but some did. Of those who did return half would be successful again. There were even some who wanted to control the gender of three or more children. This leads to a few very impressive anecdotes. It also leads to a few people getting their money back on the second, third or later child. They tended not to come again, though even some of them did having understood that there were “occasional glitches”.

    That covers the anecdotes, but how did they do the opening of the customer base? Simple really, the people who got their entire money back were not customers and so were not included. Those who stopped it being 100% successful (required for verisimilitude if nothing else) were the people who were having later children and wished to control the gender again. As stated these were a small percentage to start with, and had around a 50% of success even still.

    All in all a very large body of statistics can be assembled and can justify anything even a clearly non-useful treatment providing it is not subject to too much scrutiny. As I understand it (perhaps incorrectly) the clinics that offered these treatments generally said it was “not yet allowed under federal law” as it was “too new” and so they avoided the issue of FDA approval. People heard about it by word of mouth as the successes were more than happy to talk about it in the way the failures did not feel the need to. They had tried, been unlucky and got their money back, “nothing to boast about”.

    I am going to avoid casting nasturtiums (or in fact any other flower) at the different alternative medicines under discussion, I just wanted to point out why RCTs are more useful than anecdotal evidence.

    Rufus

  34. Anonymous says:

    Wow! So you googled the terms, huh? You must be a hard core scientist (please note sarcasm). Here’s an idea, why don’t you try putting those terms into a real peer-reviewed journal on chiropractic and see the results you get. The first journal I went to on Chiropractic lit. had a study published with over 300 subjects in it. Maybe the problem isn’t the Chiropractic but the ignorance of the person looking for info. they really don’t want to find anyway.
    By the way, you’re last name must be a joke right? Wise-man.
    And one more thing. I totally believe that Chiropractic needs more scientific proof, but when your gov’t doesn’t give you the funds to do the research it makes large double blind studies a little hard due to lack of resources. We do have research but unfortunately it has to be funded by the individuals in our profession. Very few grants and funding exist for our studies. It makes much more sense to invest money in pharmaceutical studies, marketing and pay-offs to push the drugs through testing quickly. Don’t believe me, but follow the trail of money and question what the heck is going on here.
    I’m glad you question Chiropractic and anecdotes are certainly not enough to validate our work, but there is more and more peer-reviewed scientific lit. coming out daily on a smaller (more affordable) level.
    And thank you to all of you that not only intellectually criticized Chiropractic but to those of you that showed how ignorant you are in your comments. Your nonsense reminds me of how important it is that as Dr.’s we remember that most of our audience is intellectually at a middle school level.

  35. bob says:

    I’m going to put forward an idea; obviously chiropractic makes a lot of money but if it really worked like ‘real’ medicine it would maybe make somewhere near the amount of money that pharmaceutical companies make… why do they make so much more? because it works…

  36. best boise chiropractor says:

    .., there are many sides of the coin when it comes to this Chiropractic procedure.. But I have seen it work in my friends case who happen to have a migraine before..

  37. DavidS says:

    I had to take a trip recently where I was in a car for up to fifteen hours a day and slept in strange and uncomfortable beds every night. Though I didn’t realize how much I needed an adjustment until I got home, I did realize that I was not sleeping well and didn’t “feel” 100%. As soon as I got home I called my chiropractor and was glad I did. In just one session, my neck was back where it needed to be, hips realigned again and my back felt like I could go for another month!

    When I shared this with a second cousin of mine I expected to get what I get from my mother, “You should go to a regular doctor, not one of those bone cracking guys!” However, what I heard surprised me! I found out that she and her husband have been going to their chiropractor for over twenty years and believe she has saved their lives and kept them out of the hospital over the years compared to people and relatives (my mother being one of them) that have had to be hospitalized over the past. They are in their mid seventies and neither one has been in the hospital since going to a chiropractor! What’s funny about that is they are considered the quacks in the family along with me and we are all okay with that!

  38. Your article was very interesting. The Title was very good. It catches my attention. I am sure that more blogger will going to give attention to this article.

  39. You’re very right about the plural of anecdote not being evidence. I also agree with your assessment of colic in general. However, what makes a chiropractor different than a medical doctor is that we don’t look at each patient as the “average” in a clinical study. Each individual must be assessed and treated as an individual. You would hate to be in the minority that the “standard” treatment or protocol didn’t work on. If I treated en masse, I would lend more credence to your argument. However, I treat individuals and therefore can only look to randomized, double-blinded, controlled clinical trials as a starting point for treatment rather than just blindly accepting that as a protocol for all of my patients. As Albert Einstein once said, “There is no such thing as an applied science, just the application of science.”

  40. Anecdotes are interesting and there will always be an exception to commonly accepted treatments. Being able to help their pateints is what keeps Chiropractic alive and well, both figuratively and financially. Chiropractic treatment hold value for some people and is continually becoming more accepted by the Medical community at large.

    As a good friend of mine reminded me recently, “Doctors and Lawyers are among the lucky few professions that don’t have to produce the desired results in order to get paid”.

  41. Nice choice on using google! Informative article, Thanks much,

    Dr. Vanderloop,
    Houston Chiropractor

  42. obscurantist says:

    This is just a blog and nothing less. If the author was concerned with proving his theoretical construct of “the missing study”, then why not publish it in a journal? Journals are the front line for emancipating the truth. Obviously there is no erudite information here for me to obtain. I am left aghast at the accusations made by comments usurped. If Chiropractic is falsified by the examination of medical journals, where is that evidence? All I seem to find is rants that have no place in journals. Science is still in its infancy attempting to regulate the empirical. The eldest sciences articulate laws regarding how things function. That is because these sciences (e.g. chemistry, physics, or biology) have been around for more than a century. What say you of alchemy? Did that have anything to do with chemistry? You are notably at loss because of chiropractic. You probably are someone who financially lost profit due to chiropractic, or are aggravated because that someone you know is making more money than you. There is a motivation in your blog, and I do not believe that it has to do with science. You haven’t any appreciation for scientific endeavors, hence your ranting on a blog that is not peer-reviewed. The newest sciences articulate hypothesis regarding how things function regarding its structure, and are devoid of laws. Therefore, they rely mostly on assumptions and statistical analysis (e.g. psychology or sociology), which are later tested for verification. Chiropractic worked for me. I am involved within a field of manual labor, which requires bending down all day. I couldn’t sleep at night until I found out how helpful chiropractic could be. If you want to be scientific, then seek a journal for publication. Anyone can publish whatever they want on the internet.

  43. Chirocare says:

    I really like reading a post that can make men and women think. Also, thank you for permitting me to comment!

  44. You are so awesome! I do not suppose I’ve read something like this before. So nice to discover someone with some genuine thoughts on this subject matter. Seriously.. thanks for starting this up. This website is something that is needed on the internet, someone with a bit of originality!

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