Regulation of CAM

williamgrogan

The case of Lana Dale Lewis , who was only 45, is unusual as well as tragic but you shouldn't be so dogmatic in your claim that spinal manipulation is useless and then qualify this assertion with the words 'in most cases'.

I think this is perfectly logical if you understand my meaning, which was that most of the manipulations carried out by chiropractics are useless and therefore to carry out these useless manipulations is taking un-necessary risks. It is interesting to read the above quoted web site that presumably seeks to defend chiropractic and ends up virtually denouncing it.

sextusempiricus

Originally posted by williamgrogan
I think this is perfectly logical if you understand my meaning, which was that most of the manipulations carried out by chiropractics are useless and therefore to carry out these useless manipulations is taking un-necessary risks. It is interesting to read the above quoted web site that presumably seeks to defend chiropractic and ends up virtually denouncing it.

I personally wouldn't risk a high cervical manipulation and would try and persuade my patients to avoid such a procedure. The risk, I've since discovered, is related to dissection of the vertebral artery secondary to manipulation and there is no test to predict which patients are likely to suffer. Certainly this risk seems unrelated to the usual risk factors for a cerebro-vascular event ; smoking, hypertension, hypercholesterolaemia & diabetes. Often its the younger patient who suffers. The incidence of vertebral artery dissection or blockage may be 1.3 per 100,000 manipulations. Best practice should certainly include pointing out this risk and getting written consent from the patient.
The Lara Dale Lewis case underlines the hazardous nature of this treatment but does this mean that 'most of the manipulations carried out by chiropractors are useless' .
Well I have to agree that the evidence is not good. The New England Journal of Medicine looked at physiotherapy, chiropractor therapy and an education booklet on backpain and concluded

....physical therapy and chiropractic management had similar effect and costs and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefit of these treatments are worth the additional cost is open to question.

This doesn't seem to be saying much about physiotherapy either as regards treating low back pain.

Most chiropractors are claiming much more for their therapies than a marginally better outcome for treating backache than that following written advice in a booklet. This includes not only relief of musculoskeletal problems but also help for conditions like asthma, menorrhagia, migraine and infantile colic. Here, as far as I can see, the evidence is non existent and the risks just aren't worth taking.

This still leaves the question of registration undecided. Even mainstream medicine can leave a patient crippled as I have described in my previous PS. Its therapies too have sometimes disasterous iatrogenic effects. The pros and cons of any treatment have to be carefully evaluated and this is helped by the thousands of published articles. Surely a basis for registration should be the critical assessment of the evidence base for CAM therapies too. An independent board comprising both medically qualified practitioners, lay people and CAM therapists to do this and regularly publish their findings may be the way to go and ultimately be safer for the public than the present situation where people just have no idea of the risks.
It remains impossible to register every quack but it is possible for the most popular CAM practitioners: chiropractors, osteopaths, herbalists. homeopaths and acupuncturists.

williamgrogan

The Lara Dale Lewis case underlines the hazardous nature of this treatment but does this mean that 'most of the manipulations carried out by chiropractors are useless'

I didn't say the Lara Lewis case did.

But you agree that Chiropractic "treatments" for most ailments, which consist of manipulations, are useless and therefore should not be carried out however minimal the risk is.

I suffer from Siatica. I have MRI scans that show a very "reductionist" reason. I have had physiotherapy (referred by my doctor) and while the physiotherapist was very good looking and the treatment very relaxing it was useless. In fact I suspected that it was in fact negative. I generally felt my back was even more sensitive to being further injured afterwards.

I considered an operation but felt that the probable outcomes didn't justify it, at least at present.

I find that sitting up straight in a straight backed chair, not lounging in a settee, avoiding aggressive swimming or diving and taking some brisk walking exercise virtually removes all of the problem, at least for the moment.

There is a form of regulation for medical treatments – the medical profession. Why do we need another?

PS

I fully agree with the new approach to training doctors that will oblige them to study for a Science degree first. This might eliminate the quacks who sell Acupuncture treatments.

sextusempiricus

Originally posted by williamgrogan
I didn't say the Lara Lewis case did.

But you agree that Chiropractic "treatments" for most ailments, which consist of manipulations, are useless and therefore should not be carried out however minimal the risk is.

Perhaps you are right. When I first read your statement that 'spinal manipulation is nonsense and should be illegal' I thought that you were being too vituperative. Its a matter of emphasis. I don't think I would have put it so forcefully. Low back manipulations may have a marginal benefit after all.

PS
I fully agree with the new approach to training doctors that will oblige them to study for a Science degree first. This might eliminate the quacks who sell Acupuncture treatments.

I'm sure thats a good idea. We should hope that the medical profession has its own house in full (critical) working order. The Times 'Complementary Therapists Guide' states

....the British Medical Acupuncture Society has more than 2,000 doctors as members who use acupuncture in hospital or general practice. There are more than 1,200 physiotherapists who are members of the Acupuncture Association of Chartered Physiotherapists.

In addition a good few doctors are homeopaths. What the situation is in Ireland I'm not too sure. Certainly at the scientific meetings I attend doctors may be too coy to discuss any CAM remedies they carry out.

williamgrogan

A survey (admittedly carried out by an organisation with a vested interest, they sell the three by single vaccination jabs for €100) in the UK showed that a large proportion (I think around 30%) of those families opting for the single jab over the MMR had at least one parent in “the medical profession”.

In France in Pharmacies when you ask for a flu vaccination they ask do you want the medical one or the homeopathy one.

Chemists in Ireland are now selling quack medicine as well. Unreal!

PaulP

France has long been a hotbed of quackery. All sorts of nonsense are unique to that country. Going back to the 17th century Moliere was making fun of quacks and hypochondriacs and in the 19th century Maupassant set quite a few tales among the spa-going classes. The combination of money and free time seems sufficient to kill any common sense...

PaulP

Regarding CAM among medical doctors: this is less surprising than it seems. Doctors are essentially mechanics of the human body who apply scientific discoveries (from chemistry, biology and physics) in a clinical setting. They are no more qualified to overthrow say the laws of chemistry (when espousing homeopathy) than a car mechanic the law of the lever.