Do not wish to be associated w/ II

Oh Michael is right- I am still a student- have 3 months to go now Finals start in May- paediatrics written exam first, then two days later I have the medicine and surgery written exams (with negative marking T/F MCQs ) . Then throughout May I have clinical examinations with consultants/ professors specially brought in from Hell. They are heavily into intellectual masturbation which irritates me! i guess it would be bad form to tell the examiners to shut the fuck up during the finals? I should pass the exams, provided my confidence doesn't drain away. It's interesting but I have noticed in mock exams that even if you miss things out but are confident they think higher of you than if you manage to include everything in a full examination but appear nervous. Maybe I should snort some coke or something beforehand then!

On a tangent- but today's <a href="http://bmj.com/" target="_blank">BMJ</a> has a really amusing front page- It shows a scanning electron microscope image of a house dust mite atop a needle point- "Homeopathy for dust mite allergies?"- subtext "No, it's a waste of time". I found it amusing. I am aware that this topic is about acupuncture and also has a sizeable focus on chiropractice, but I found this really funny. The BMJ is free online so I would advise everyone to go and read it. In there are some good study designs, and occasionally really bad ones! Bear in mind as well that it is usually just the positive results that get media coverage- you can bet your bottom dollar that for every article in the BMJ, the Lancet or NEJM there are dozens of negative studies languishing in some university department's archives or being published in some obscure journal few have heard of. Indeed to that extent the negative homeopathy article above is unusual.

[ March 01, 2002: Message edited by: Thomas McPhee ]</p>

Francois Tremblay

BTW not only is there no evidence for chiropratic, but I just found a study on Chirobase that purports to show that the basis for the discipline is fradulent. It was only done on 6 people, though. Still interesting.

<a href="http://www.chirobase.org/02Research/crelin.html" target="_blank">http://www.chirobase.org/02Research/crelin.html</a>

Also here is a page listing studies (relevant studies, not spinal modeling nonsense) about chiropratic.

<a href="http://www.chirobase.org/02Research/journals.html" target="_blank">http://www.chirobase.org/02Research/journals.html</a>

Here is the list on this site... so that anyone can see how more relevant these studies are. No bullshit on the skeptic's part.

Assendelft WJJ, Bouter LM. Does the goose really lay golden eggs? A methodological review of workmen's compensation studies. JMPT 16:161-168, 1993.
Carey TS and others. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. New England Journal of Medicine 333:913-917, 1995.
Shekelle, PG and others. The effect of cost sharing on the use of chiropractic services. Medical Care 34:863-872, 1996.
Skargren EI and others. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine 23:1875-1883, 1998.

French SD, Green S, Forbes A. Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. Journal of Manipulative and Physiological Therapeutics 23:231-238, 2000.
Haas M. The reliability of reliability. Journal of Manipulative and Physiological Therapeutics 19:199-208, 1991.
Hestoek L, Leboeuf-Yde C. Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. Journal of Manipulative and Physiological Therapeutics 23:258-275, 2000.

Aker PD, Martel J. Maintenance Care. Topics in Clinical Chiropractic 3(4):32-35, 1996. [Two Canadian chiropractors who conducted an extensive literature search found no scientific evidence supporting the widely held chiropractic belief that periodic spinal adjustments improve health status.]
Gunnar BJ and others. A comparison of of osteopathic spinal manipulation with standard care for patients with low back pain. New England Journal of Medicine 341:1426-1431, 1999.
Hawk C and others. Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine. JMPT 22:382-389, 1999.
Shekelle PG and others. Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America. Annals of Internal Medicine 129:9-17, 1998.

Assendelft WJJ and others. The relationship between methodological quality and conclusions in reviews of spinal manipulation. JAMA 274:1942-1948, 1995.
Assendelft WJJ and others. The effectiveness of chiropractic for treatment of low back pain: An update and attempt at statistical pooling. JMPT 19:499-507, 1996.
Balon J and others: A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. New England Journal of Medicine 339:1013-1020, 1998.
Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: A randomized controlled trial. JAMA 280:1576-1579, 1998.
Cherkin DC and others. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. New England Journal of Medicine 339:1021-1029, 1998.
Jordan A and others. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial. Spine 23:311-318, 1998.
Koes BW and others. Spinal manipulation for low back pain: An updated systematic review of randomized clinical trials. Spine 21:2860-2873, 1996.
Lantz CA, Chen J. Effect of chiropractic intervention on small scoliotic curves in younger subjects: A time-series cohort design. Journal of Manipulative and Physiological Therapeutics 24:385-393, 2001.
Olafsdottir E and others. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Archives of Diseases in Childhood 84:138-141, 2001. [No benefit was found.]
Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies. JMPT 24:514-519, 2001.


The web site links to abstracts of each paper. Most of them are pretty damning of the anti-scientific mindset of chiros and the ineffectiveness of their methods.

Corwin

'Evilution can't work because we've never seen a dog give birth to a CAT!!!!!!'

Francois Tremblay

Spoken like a True Believer. Keep a stiff upper lip in the face of overwhelming evidence against you and hang on to undocumented anecdotes, that's the ticket. You're well on your way to become a Creationist (^_^)

[ March 01, 2002: Message edited by: Franc28 ]</p>

Corwin

Clearly 'Irony is not spoken here.'

bluefugue

I dunno, I think Franc's smiley might indicate he was in on the joke...

Corwin

That's a smiley?

pulpyboy

Franc28,

Finally you have posted something of merit. The list of research articles, a total of 21 if I counted correctly, presents some of the problems that exist in chiropractic today. As an aside, I want to thank you for posting the link as it allowed me to discover pub med. Type in a search for spinal manipulation and up pops 543 listings. Type in chiropractic and get 2587 articles. What a great resource. So in all sincerity, thank you.

Now back to your post. I am not sure if you read all the citations listed on the chirobase page. Some of them are not all negative while others certainly are more negative. The list is something I would expect to find on a website such as chirobase.
Now I am not sure how all of my profession can be said to have an anti-scientific mindset when there is continued scientific research being published by aforementioned anti-scientific members including research that is not favorable to currently held ideas. Is that not science? One postulates a theory and then does research to test that theory. Results of tests either lead to more tests, changing of the theory, or dismissal of the theory.

A couple of the studies that you cited including some on the risk of spinal manipulation, I have seen disputed by other research articles. Obviously, those articles are not linked to by chirobase. My malpractice rate seems to infer that what I do is extremely safe.

The reason that I think that the data I posted is relevant points to a problem that I have seen within my profession. For years, chiropractors have told their patients that something in their spine is abnormal. However, how can you describe something as abnormal until you define normal? After defining normal, you must be able to state why it is deleterious to be abnormal. Then you must test whether your intervention is able to return someone to normal. This sort of research is exactly the kind of research that needs to be done in chiropractic.

There have been over 50 randomized controlled studies that support spinal manipulation for low back pain. There are other studies showing the effectiveness of manipulation for neck pain and headaches. There are also studies that suggest that manipulation may have an effect on some disorders not neuromusculoskeletal in origin. In my opinion, there continues to be a need for more and better defined research. In an earlier post, I cited an article that said that only 15% of medical interventions are solidly backed by scientific evidence. I believe that in my own profession that number is probably significantly smaller. Hopefully the numbers for all health related professions will continue to increase rapidly.

As an aside to Thomas McPhee. Good luck on your exams. I agree with you that during oral exams you are also being graded on your demeanor, confidence, and ability to think on your feet. I am sure that you will do well.

Respectfully,
Michael

bluefugue

Yes. ^_^

Corwin

Ok I've never seen a smiley done like that before.

I still find it ironic that he's using exactly the same technique the creationists use.... attempting to disprove our point by bringing up a disproven point that we don't claim is valid in the first place.