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The Carbon Pot Calling The Kettle Black

THE CARBON POT CALLS THE KETTLE BLACK. – A STORY OF DOUBLE STANDARDS.  CHIROPRACTIC BALANCES THE BOOKS.

 By P.L Rome DC

Of late, there seems to be somewhat of a concerted campaign against chiropractic.  As such, there seems to be a need to make a few important observations in defense from uninformed or biased opinion.

Firstly there is indeed refereed evidence published in journals in support of chiropractic hypotheses.  Much of this evidence is in the medical literature itself.  It is deceptive to claim otherwise, or to ignore that evidence – especially if one deliberately chooses not to read it.  Therefore, to claim that chiropractic is not evidenced-based is false and deceptive.  Apart from the various medical texts and journal papers on spinal manipulation covering a variety of disorders, perhaps the most compelling evidence is by Sato et al, from Japan, – all 328 pages of it.(1)  Given his qualifications and research experience, I would submit that Professor Sato’s opinion carries far more weight than any critics.

Secondly to give the impression that chiropractic is harmful to children or adults is a gross distortion.  There can be risk with any intervention, be it vitamins and over-the-counter drugs, to prescription drugs and surgery.  However, the overwhelming evidence is that spinal manipulation in the hands of an appropriately trained professional, is one of the safest.  An extensive study recently confirmed that for human patients under the care of appropriately qualified providers, cervical vertebral manipulation is a relatively safe procedure.  Cassidy and colleagues analysed 818 stroke patients representing “more than 100 million person-years. ”They concluded that patients under chiropractic care were no more at risk of stroke than patients attending medical practitioners.(2)

In relation to interventions, medicine coined the terms iatrogenesis and risk-benefit ratioin recognition of this.  If an evidence base was the prime criteria for therapeutic care, one wonders why so many drugs are withdrawn from the market, and why the term adverse effects has been broadly adopted – and seemingly acceptable.

Archer’s 1995 book, Bad Medicine was based upon some of the medical data about iatrogenesis - permanent harm or death arising from medical treatment, as distinct from the patient’s disorder. He estimates 50,000 iatrogenic deaths and 750,000 permanent injuries per year in Australia through his interpretation from the medical data.(3)

US researchers, including three MDs and a PhD, used a framework of categories of iatrogenesis in which to sort all of the available medical data into an orderly way of portraying the full picture of the entire spectrum of an iatrogenic epidemic. They claim: “The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year. It is now evident that the American medical system is the leading cause of death and injury in the US.” (4)  Given Australia’s population is approximately 1/10th that of the US and the health care system is comparable, one may assume that based on the same calculations, Australia’s statistics could be in the order of 78,400 iatrogenic deaths annually –if accurate records were kept.

Surely it is about time in health care, that patients' preferences, desires and demands took priority, rather than the elimination of other models of health care that have been proven to help at least some patients.  Internationally at least, there is collaboration and cooperation between recognised health professions.  Chiropractors are now retained in some US and European hospitals, the US armed forces, and as triage doctors by some insurance companies.  It is therefore obvious that at least some authorities see that chiropractic does have something different and distinct to offer in the form of health care.

To have one profession dominate, and command all others, is contrary to the interests of consumers in any industry.  The health care field needs and cries out for healthy collaborative and cooperative competition to the benefit of patient outcomes and health care in general.  In addition, patient demand and choice should dictate preferences in treatments - as long as positive results are obtained.

A recent study commissioned by the publication; Australian Doctor and the drug company Pfizer Australia, showed chiropractic was by far the most popular of what they termed alternative therapiesin their survey. The study was a national survey of 1250 patients in Australia. The results showed that 34% of patients had visited a chiropractor.(5) 

At least in the US, concern about medical errors and the dangers of hospital-acquired infections has been building for more than a decade amid growing evidence that the nation's hospitals are not as safe as was commonly believed.(6) 

The following quote from Scientific American this year is particularly relevant;  We could accurately say, "Half of what physicians do is wrong," or "Less than 20 percent of what physicians do has solid research to support it." Although these claims sound absurd, they are solidly supported by research that is largely agreed upon by experts. Yet these claims are rarely discussed publicly. It would be political suicide for our public leaders to admit these truths and risk being branded as reactionary or radical. Most Americans wouldn't believe them anyway. Dozens of stakeholders are continuously jockeying to promote their vested interests, making it difficult for anyone to summarize a complex and nuanced body of research in a way that cuts through the partisan fog and satisfies everyone's agendas. That, too, is part of the problem. "(7) 

At least that Scientific American figure is an improvement on the British Medical Journal's editorial in 1993 which stated, "...only 15% of medical interventions are supported by solid scientific evidence...(and)...only 1% of the articles in medical journals are scientifically sound...many treatments have never been assessed at all..."(8)  That 15% up to only 20% is a 33% improvement! 

To complicate health issues further, "In a review of studies published in The Cochrane Library, researchers found that both doctors and patients are largely unaware of these different and equally accurate ways of presenting the same information, and that the format in which data is presented can have a profound influence on health care decisions."(9) 

The concept of evidenced based medicine is under question.  It would appear that it does have shortcomings.  Rosner confirms that the concept of " Evidence-based medicine (EBM) is beset with numerous problems."  He concludes that "Finally, the blinding concept of randomised controlled trials is particularly problematic in applications of physical medicine. Examples from the research literature in physical medicine highlight conclusions which are open to debate. More progressive components of EBM are recommended, together with greater recognition of the varying audiences employing EBM." (10) 

But he is not the only one to raise reservations about EBM.  Pring cites a very relevant quotation by noting “…that the definition of evidence remains contested, and there has not been enough attention to values, perceptions and the consumer perspective.” .(11)  In discussing the appropriateness of EBM, Borgerson noted that “The validity of evidence-based medicine (is) the subject of ongoing controversy” (12)  Just last year, Kerridge raised the issue of neutrality in EBM.(13)  This is not to say that EBM does not have a role, but that it may not be the total answer. (14,15)  Pirotta claims that “It is estimated that as little as a quarter of conventional medicine is based on Level-1 evidence.(16) 

It should also be noted that  “If the chiropractic approach to low back pain had been abandoned early on due to the lack of research data, we would have never known its superiority to other conservative treatments.”(17)  A restraint on chiropractic denies patients any potential under its care, especially if critics have never fully and scientifically tested the model. 

It is noted that often claims constitute mere opinion, no research or supporting scientific studies are cited.  One would be all in favour of journalists or others expressing their personal opinions, but as long as it is done in perspective, with an accurate reflection of the facts rather than unsubstantiated claims. 

Within medicine itself, there is divided opinion while more than 50% of Australian seek some form of alternative health care annually.  A past president of the AMA, and current president of the Australasian Integrative Medicine Association,  Dr Kerryn Phelps states that opposition to evidenced-based complementary medicine options is “prejudice dressed up as opinion,” and that it is“…completely unbalanced, completely out of touch, and it’s in denial; of the level of scientific research…” Dr Phelps goes further in response to recent criticism on alternative therapies by Prof Dwyer by claiming that “He doesn’t work in this area and doesn’t know what we do.  The published data is there.  He is either unaware of it, or he’s not looking,” she says.(18) 

Finally, in the interest of fair play, critics of chiropractic should balance their opinions with further reading – and these are only some of the books available. (3, 20-34) 

Most pertinently, the statement by Knipschild in the Lancet in 1993, carries as much importance today as ever.  "It is a pity that the message does not appear to have been heard. He stated, "They (patients) continue to choose the treatment that they expect to give them the best overall benefit" (35)

 

P L Rome DC

References

1.  Sato A, Sato Y, Schmidt RF. The impact of somatosensory input on autonomic functions. In: Reviews of Physiology Biochemistry and Pharmacology. Blaustein MP, Grunicke H, Pette D, Schultz G. Schweiger M, Habermann M, editors: Berlin Springer-Verlag,. 1997;130, 328pps.

2.  Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case crossover study.  Spine 2008;33(4 Suppl):S176-183.

3.  Archer, John. Bad Medicine: How Safe Is Modern Medicine. Simon and Schuster Australia, East Roseville, NSW. 1995. P184.*

4.  Faloon W. As We See It, Dangerous Medicine. Life Extension Magazine. March 2004. http://www.lef.org/magazine/mag2004/mar2004_awsi_01.htm

5.  Howe M. Hope, not science. driving trust in alternative therapies. 2005;July 27. http://www.australiandoctor.com.au/news/de/0c0322de.asp.*

6.  Obama announces new effort to cut medical errors that cost thousands of lives & millions of dollars. LA Times Health March 30/April 1st.

7. Kumar S, Nash DB.  Health Care Myth Busters: Is There a High Degree of Scientific Certainty in Modern Medicine? Two doctors take on the health care system in a new book that aims to arm people with information. Scientific American 2011;28: March 25.

8. Smith R. Where is the wisdom...? The poverty of medical evidency. Editorial. British Medical J 1991;303(Oct 5):798-799.

9.  Bakalar N. Translation matters in choice on data. New York Times. May 30th 2011. www.nytimes.com/2011/05/31/health/31data.html

10. Rosner AL. Critical Review. Evidence-based medicine: Revisiting the pyramid of priorities. J Bodywork and Movement Ther. 2011 doi:10.1016/j.jbmt.2011.05.003 (Article in Press)

11. Pring B. State of the (global ) nation. Evidenced-based medicine. Aust Medicine. 2002;Jan 7-21:12. (Citing Prof. Zwi).*

12. Borgerson K. Evidenced-based alternative medicine. Perspectives in Biology and Medicine. 2005;48(4):502-515.

13. Kerridge I. Ethics and EBM: acknowledging bias, accepting difference and embracing politics. J Eval Clin Prac/ 2010;16(2):365-373.

14. Celermajer DS. Evidence-based medicine: How good is the evidence? Med J Aust 2001;174(7):293-295.*

15. Simon SD. Is randomised clinical trial the gold standard of research? J Andrology 2001;22(6):938-943.

16. Pirotta MV. Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base? – Yes. Med J Aust 2011;195(2):78.

17. Plaugher G. Spinal management for the patient with a visceral concomitant. Chapter 13. In: Plaugher G.(ed). Textbook of clinical chiropractic: A specific biomechanical approach.  Baltimore: Williams & Wilkins; 1993. p.256.

18. Cresswell A. Uproar on the road to healing. Weekend Australian. Health Supplement.  July 16-17, 2011; 10.*

19. Carter JP. (MD) Racketeering in medicine.  The suppression of alternatives. Norfolk, Va: Hampton Roads Publishing Co.1993.

20. Smith JC. (DC) The medical war against chiropractors. The untold story from persecution to vindication. Self published, 2011.

21. Wilk CA. (DC) Medicine, monopolies and malice. New York. Avery Publishing Group. 1996.

22. Goldacre B. (MD) Bad pharma. How drug companies mislead doctors and harm [patients. London: Fourth Estate. 2012.

23. Burch D. Taking the medicine. London: Vintage Books. 2010.

24. Makary M. (MD). Unaccountable.  What hospitals won’t tell you and how transparency can revolutionize health care. New York. Bloomsbury Press. 2012.

25 Coleman V. Betrayal of trust. European Medical Journal. Lynmouth, Devon; 1994.

26. Taylor R. Medicine out of control.  The anatomy of a malignant technology. Melbourne: Sun Books.1979.*

27. Wolinsky H, Brune T. The serpent on the staff. The unhealthy politics of the American Medical Association.New York: GP Putnam’s Sons;1994.

28. Landymore-Lim L. Poisonous prescriptions. Subiaco; PODD. 1994.*

29. McTaggart L. What doctors don’t tell you. London: Thorsons – Harper Collins. 1996.

30. Moynihan R. Too much medicine? The business of health – and its risks for you. Sydney:ABC Books. 1998.*

31. Rice S. Some doctors make you sick. The scandal of medical incompetence. North Ryde: Angus & Robertson; 1988.*

32. Taylor R. Medicine out of control. The anatomy of a malignant technology. South Melbourne.: Sun Books. 1979. *

33. Coleman V. Betrayal of trust. Lynmouth, UK: European Medical Journal. 1994.

34. Wolinsky H. Brune T. The serpent on the staff. The unhealthy politics of the American Medical Association. New York: GP Putnam’s Sons. 1994

35. Knipschild P. Searching for alternatives: loser pays. Lancet 1993;341:1135-1136.

 

* Australian citations

 

 

Your Chiropractor

Michael McKibbin passed his Iowa Basic Science and graduated from Palmer College of Chiropractic in Davenport Iowa.

Since then both wonderful staff and patients have contributed toward decades of valued experience in his family practice.

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