Oct 16 2008

Chiropractors Invade My Blog

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Comments: 120

Recently several chiropractors have been posting comments on this blog, under the blog entry about a law suit over a stroke allegedly due to a chiropractic neck manipulation. A detailed-enough response to the several long comments is worthy of its own entry, so here it is.

First, I want to point out that I greatly appreciate when readers post contrary opinions on my blog. Agreement (while also appreciated) is boring and does not advance the discourse. If I am missing an important piece of information, or my logic is flawed, I love having it pointed out – that way I can make corrections. I want my arguments to be both valid and as complete as possible, so corrective feedback is very valuable.

I also greatly enjoy sparring with those who have used logic and evidence to come to a different conclusion from me. A constructive discourse can only be a learning experience all around. I find I understand a topic much better after having to defend my position to someone adverse to it and who is using every argument they can muster to take it down.

Even those who are closed-minded and ideological can serve a purpose, if only as a spur to discuss real science, and as an example of how thinking can go wrong (creationists are the poster-child for this, but there are plenty of examples).

The chiropractors who have posted here recently bring up many common points, and so readers are likely to encounter them elsewhere. “Cause and Effect” writes:

Yet, many posts could be quoted to the “Anecdotal” nature of us Chiropractors. In MY OPINION, if you were a true scientist, you would commend these anecdotes and suggest further research, rather than write them off as here-say and folly. All good scientists produce their proof or lack-there-of from a single thought. Such was the case in the early 1900’s with the advent of medication to relieve ailments. It began as a thought, was promoted by those in business and has remained as such since.

A certain red flag for medical quackery is the unqualified defense of anecdotal evidence. It is an appeal for a lower quality of evidence to trump a higher quality of evidence, and significantly downplays the serious limitations of uncontrolled observations. Cause and Effect defends it by attacking a straw man – that my position is that anecdotal evidence is all written off as “folly” and should not even be used as a basis for further research.

I have written a thorough entry just on this topic over at Science-Based Medicine, called The Proper Role of Anecdotes in Science-Based Medicine.  Briefly, I acknowledge that anecdotal observations are properly used as a starting point for generating hypotheses that can later be tested by controlled experiments. However, they are too low-grade a type of evidence to be used as a basis for a scientific conclusion. Promoters of unscientific medicine are often profoundly confused about the difference between generating hypotheses, and forming conclusions upon which it is reasonable to base therapies.

Another consideration that must be added to anecdotal observations in generating hypotheses is plausibility. Not all ideas in science are equal. Prior probability is an important consideration in determining how scarce research resources should be allocated, and also in what experimental therapies to which it would be ethical to subject patients.

But also notice the common ploy Cause and Effect uses of framing their position as just advocating for research – what can be more reasonable than that – and trying to say that I am not scientific because I am against more research. There are many problems with this position, however. First – I recognize the utility of anecdotes in deciding what is worthy of research (put in the proper context of plausibility), so it is a straw man. Second, there has been research on many of the basic premises of chiropractic and specific therapies. True-believers simply ignore negative evidence and endlessly call for more research – it’s nothing more than a ploy to keep the game going for as long as possible.

The last sentence regarding medication is also very telling: “It began as a thought, was promoted by those in business and has remained as such since.” Cause and Effect is missing an important step in this process – testing the “thoughts” with well-controlled clinical trials to see if they are actually true. Most are not.

Cause and Effect writes:

For example, If you were to witness for yourself a patient with any of these conditions change at the hands of a Chiropractor….For instance, let’s say a child who is instantly relieved of his or her seizure…A common anecdote of a Chiropractor…would you agree that research is warranted? Or would you write it off as coincidence? What if it happened time and time again as it does on a regular basis in Chiropractic offices? Would it be a series of co-incidences and anecdotes or would you then agree that research to the benefits of ADJUSTMENTS (not manipulations) are warranted?

What does that mean to be “instantly relieved” of a seizure?  This is an incoherent statement. Seizures are events. They last 1-3 minutes typically, which means they stop spontaneously. So anything you do during a seizure will be followed rapidly by the seizure stopping. Coincidence alone is enough to explain the occasional, even frequent, association between an intervention (like an adjustment) and the end of the seizure. Only statistical information would be able to tell if the seizure duration were actually decreased, since you can’t know how long the seizure would have lasted.

The only exception to the fact that seizures stop on their own is status epilepticus (a continuous seizure) and it is gross malpractice to treat status epilepticus with anything other than accepted emergency protocols.

So the anecdotal observation of seizures stopping is very problematic. If there were any plausibility to such an observation, that might warrant a pilot study – gathering some statistical data – to see if more elaborate research were indicated. But there is no plausibility to a specific effect from a chiropractic adjustment to altering the course of an electrical event in the brain. There may be non-specific effects from generic sensory feedback (depending upon the type of seizure), but even that is highly questionable. In some patients stimulating part of the brain may prevent the spread of a focal seizure (a seizure that is occurring in just part of the brain, not the whole brain), but it does not stop the seizure instantly. It is also highly unlikely that an adjustment would provide the specific type of brain activation that would have this effect.

It should also be noted that not everything that shakes is a seizure. One hallmark of a seizure is that it cannot be stopped by interacting with the patient, and this is often done to help distinguish a true seizure from a non-epileptic mimicker.

Further, there are no controlled studies supporting the use of chiropractic to treat epilepsy (reduce the frequency of seizures) or to treat seizures in progress. There are only case reports and aggregates of those case reports. Chiropractors have made no progress in research – they have not explored any plausible mechanism, and they have not established that there is a real effect. They are stuck in the starting box – presenting anecdotes. They claim that this justifies further research, but then never do that research. Rather, they use anecdotes to justify treatment, which is completely inappropriate, even unethical.

Imagine if a pharmaceutical company tried to market a drug for seizures and offered as supporting evidence only uncontrolled anecdotes. Imagine further that they dismissed reported cases of liver failure occurring after taking their drug as coincidence.

Next we are given anecdotes about asthma:

I myself was a medical “failure.” As a teen, I was diagnosed with “Asthma” and was told there is no cure, but it can be controlled and treated with medication. That was a risk/benefit decision that I choose to take, although against my judgment. After multiple years of medication, I found a Chiropractor who adjusted my neck subluxations and my asthma went away; I threw away my medications and haven’t looked back since. The only change I made was to be adjusted. Even today, in our Chiropractic office, people with “asthma” find they no longer need their medications, breathe easier and enjoy life to the fullest potential they dream of. Doesn’t that warrant further investigation?

The exact same criticisms apply – there is no plausible mechanism, and all we have are anecdotes. Also, asthma attacks, like seizures, are unpredictable events and are subject to a host of psychological and lifestyle factors. This means they are very susceptible to false-positive observations – it is easy to think there is an effect from an intervention when there isn’t.

In the case of asthma, however, we actually do have some clinical trials. A recent Cochrane systematic review (which I should note does not factor in the lack of plausibility) of manual therapy for asthma concluded:

“There is insufficient evidence to support the use of manual therapies for patients with asthma.”

Another review in the Annals of Allergy Asthma and Immunology from 2004 concluded:

“There is currently no evidence to support the use of chiropractic SMT as a primary treatment for asthma or allergy”

Perhaps the single best designed study of chiropractic and asthma was published in 1998 in the NEJM –A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. This study was well-designed and was a collaboration among chiropractors and MDs. The results were dead negative:

In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.

Of course, after the results were in chiropractors complained, and of course no study is perfect so there were nits to pick. But this study represents the best evidence to date – and don’t forget the recent systematic reviews that also show no evidence. If this were a mainstream medical intervention, it would be dead in the water. If proponents of the treatment did not want to give up, then the onus would be on them to design better and more definitive studies and show a real effect, or admit defeat and move on.

Chiropractors did what non-science-based practitioners do – they complained but then never did the follow up studies. Instead they went backwards, doing pilot studies and case reports. The high quality evidence was against them, so they went back to low quality evidence where false-positives are common.  What they did not do was stop promoting adjustments for asthma – the one adjustment they did not make was adjusting their practice to the best scientific evidence.

Instead we get the endless cycle of anecdotes and cries for more research, all the while practice continues without change. Again – imagine a pharmaceutical company doing this.

Cause and Effect next writes:

Secondly, it is the treatment that is of concern to the Chiropractor, as we do not “treat.” For example, Hypertension…a typical medical scientific approach is to administer a medication to lower blood pressure….at least that is what my patients and friendly MDs tell me…but why? To lower the “number?” Why not then lower the BP when a person is exercising? The body has driven it up to accommodate the need of increased blood flow (due to exercise); but it is now “not normal” according to medical standards; it is above “normal.” Hypertension is the same…the body reacting to an increase in “exercise;” a situation that requires increased blood flow.

This is a juicy straw man – attacking a childish caricature of modern medicine rather than actual practice. This is not to say that there are no bad doctors out there, of course there are. But they do not represent the standard of care.

In general, good clinical practice includes avoiding the temptation to simply treat numbers. I teach this to medical students all the time – what are you actually treating? Are you just trying to make yourself feel good by making the numbers better, or will this help the patient?

However, with blood pressure, we do treat the number. That is because high blood pressure is the “silent killer” – it usually causes no symptoms but it increases the risk of strokes and heart attacks. This increased risk correlates with the number – so yes, we treat the number as a preventive measure. This is real, effective, preventive medicine based upon rock solid scientific evidence and plausible and well-established mechanisms.

Notice the further silly straw man he includes: “Why not then lower the BP when a person is exercising?” This represents a gross misunderstanding of the standard of care. Hypertension is diagnosed on the basis of chronically increased blood pressure at rest. In fact, the diagnosis of hypertension needs to be confirmed by multiple measures. We even worry that the patient’s blood pressure might be artificially elevated because they are anxious about their doctor visit, so-called “white coat hypertension.” We do not want to treat blood pressure that is physiologically elevated due to normal sympathetic activity, from exercise or even anxiety, only primary hypertension – “primary” means it is not secondary to a normal physiological cause.

Much of the rest of Cause and Effect’s comment has to do with a misunderstanding of risk/benefit analysis. He writes:

When people DIE due to medication, liver damage is due to medication, kidney failure is due to medication…When proper medical protocols are followed and people DIE…when the wrong organ is removed, or the wrong knee is operated on…when does the risk/benefit need to be re-evaluated? The ratios are minimal, yes, but so to are the ratios of Chiropractic and stroke.

The answer is, that risk/benefit ratios are constantly evaluated and re-evaluated in medicine.  And (this is an important bit) medical practice actually changes in response to such analysis. For example, felbatol was a new anti-seizure drug that came on the market about a decade ago. It was demonstrated to be safe and effective in large double-blind clinical trials. There was far more evidence for the safety and effectiveness of this drug than for chiropractic neck manipulation for any indication. Once on the market, however, there were reports of a number of cases of liver damage. The FDA says: “THE REPORTED RATE IN THE U.S. HAS BEEN ABOUT 6 CASES OF LIVER FAILURE LEADING TO DEATH OR TRANSPLANT PER 75,000 PATIENT YEARS OF USE.”

This resulted in the immediate suspension of the drug while the data was reviewed. Then the FDA decided that a black-box warning was indicated, with liver monitoring in patients on felbatol. Prescriptions for felbatol plummeted, as the new risk/benefit assessment favored the use of other safer drugs for most patients. I have not seen a patient on this drug in the last 10 years, especially since there are now newer anti-seizure drugs with no reported liver or other organ toxicity.

There were fewer cases of liver failure from this drug than reported cases of stroke following chiropractic neck manipulation, so why hasn’t the chiropractic community responded in a way similar to the medical community? Some chiropractors rail against the risks of mainstream medicine, ignoring the benefits, while they promote treatments without proven benefit and ignore their own risks.  They then have the nerve to accuse physicians of applying a double standard.

Another chiropractor, carpdc, writes:

The good neurologists pontificating is one example of the deity complex that has gotten medicine to be so mistrusted by the average consumer today. We are continuing to fund good studies in chiroipractic and I would welcome you to my practice with open arms so that we can come together and do what serves patients best.

The dismissal of legitimate criticism as “pontificating” from a “deity complex” is a classic ad hominem logical fallacy.  While referring vaguely to “good studies” carpdc only offers anecdotes to support his practices. He offers to have me visit his practice, so that I can add my own anecdotal observations to the mix – missing the point that my anecdotal observations are no better than anyone else’s. How about some controlled clinical data?

Further, while offering to “come together” he then writes:

Let’s leave medicine to what it can competently treat which is acute trauma and life threatening situations. Medicine must do better though. It is vastly inadequate in answering the rise of degenerative diseases and woefully inadequate in the maintenance of health. This is where chiropractic is FAR superior to allopathy.

He is dismissing all of medicine that does not deal with trauma or acute life-threatening situations, which is most of medicine and just about all of my practice as a neurologist.  Of course medicine can and should do better – this will always be the case. But he is implying that our approach to health maintenance is misguided or wrong, which is based upon nothing but propaganda.

He then follows up with the outrageous claim that chiropractic is “FAR” superior to “allopathy.” Allopathy is not a meaningful term. It is a derogatory term invented by Hannheman, the inventor of the fairy tale known as homeopathy, to denigrate the practices of the time. Modern medicine does not have much relationship to what he dismissed as “allopathy.”

Also, I challenge carpdc to provide adequate evidence to show that chiropractic is superior to science-based medicine for anything, let alone far superior for all health maintenance and degenerative diseases.

Given these statements, I can only conclude that carpdc is insincere in his offer to “come together.”

Finally, Nwtk2007 joined the frey with this:

The ratios in chiro are much, much better than in medicine when chiro is appropriate.

The bloggers here only admit to benefit for uncomplicated low back pain but evidence has been posted supporting chiro for neck pain and HA, but they refuse to even read it or consider it, thus they feel there is never a good reason to do cervical manipulation based upon their assessment of the “risk to benefit” ratio.

Again, an unsubstantiated claim for chiropractic superiority, and an unwarranted ad hominem.  In fact, I and my colleagues at Science-Based Medicine, as well as many other science bloggers, make a specific effort to read and review published evidence. And again, I have nothing against manipulation as a treatment modality, I just want it to be science-based.

While  Nwtk2007 accuses us of refusing to look at evidence, he does not provide anything specific.

But, TheTruth (I admit I always have a negative reaction to anyone attempting to grab the mantle of “Truth”) does offer a specific reference – http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure.

This is a small (50 subjects) pilot study – even the study authors label it as such in the title. A small pilot study of an implausible treatment is not convincing. This is not a double-standard – I would not be compelled by such evidence for any implausible treatment, and not even for a plausible treatment if that was all there was.

Individual studies, or small numbers of pilot studies, are simply not compelling. Remember the research of John Iaonnidis – he convincingly showed that most published medical studies are later refuted by better studies. Also, the risk of this increases with the implausibility of the treatment.

What science-based practitioners rely upon are studies that are well-designed and reproducible – the kind of studies that eventually evolve out of those pilot studies.  Chiropractic has not been able to produce such studies for any of the medical claims made for it. There have been enough studies to show a symptomatic benefit for uncomplicated lower back pain, but no better than other standard treatment modalities.

But for asthma, seizures, blood pressure, headaches – no. Just mixed results from small studies, and chiropractors cherry pick the positive ones.

I think the quality of the arguments put forth by the chiropractors trying to defend their profession speak for themselves. But further, I am struck by the hypocrisy of whining about evidence-based criticisms of chiropractic in the same comments that make outrageous and unsupported attacks on mainstream medicine.

120 responses so far

120 thoughts on “Chiropractors Invade My Blog”

  1. Jim Shaver says:

    Dr. Novella rocks! (I know, it’s not an opinion that advances the discourse; it’s just a fact.)

  2. w_nightshade says:

    Watching you respond to arguments is one of my favourite spectator sports – it is like watching Kasparov play chess, like watching Baryshnikov perform ballet. Except you are not Russian. Excellent post once again, Dr. Novella.

  3. Fred Cunningham says:

    I have read on a number of occasions that frequent measurement of BP tends to lower it. Because there are so many factors affecting BP readings, it would take a large amount of data to show any effect. Many years ago there was an article in “American Scientist” on the impossibility of manually adjusting the spine and I’m sure there has been no properly done testing by reading of x-rays to show changes in alignment. That article on Webmd sure reads as bogus.

  4. Eric Thomson says:

    Excellent work on this post.

    You said there is evidence that chiropractic care reduces lower back pain–do you happen to have links to any of the studies? I find this an interesting subtopic.

  5. TimH says:

    To my eternal shame I visited a Chiropracter with a very sore lower back whilst living in a very rural area, to the scorn of my Physiotherapist friend.

    She asked me where the pain was and then drew a lovely RED patch on a chart of the back EXACTLY where I said the pain was and then said that this was her diagnosis—- my back was sore…

    As a fully qualified Audiologist serious bollocks alarm bells began to ring out loud and clear when she told me Chiropracty is based on the work of a chap who manipulated the neck (THE NECK) of a deafened janitor and cured his hearing loss. UTTER physiological twoddle of the 1st order. But she had £200 of my money so I continued to attend her “treatments”, which mainly involved myself and three or four other gulls lying face down on very comfy massage tables and having our backs touched gently and ineffectually by her finger tips whilst listening to nose-flute playing.

    Sadly I carried on attending despite absolutely no benefit to my back (although I quite enjoyed the little snooze on the couch) until one day I walked in to see a card on the desk in beautiful calligraphy that said “All healing is spontaneous and magical”. At this point reality crept up and slapped me round the face. I stopped going. My back got better. Magic 😉

    Love the Blog, Podcast and Ethos,


  6. tooth fairy says:

    there would be evidence but mostly no bigger than noise effect size and once you start to test the hypothosis under a well designed and controlled test it would fail or not produce a compelling enopugh result to base chiro as the primary treatment. and even more it would be hard to distinguish wheather the patient had been relieved of the pain by the manipulation or by some other happy coincidence or even by the massage or touch that goes before the manipulation

  7. Chicago Skeptic says:

    Eric –

    Check out the Cochrane Foundation review “Spinal manipulative therapy for low-back pain (http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000447/frame.html). The review includes citations to the 39 studies used to form their conclusion.


    Chicago Skeptic

  8. Joe says:


    Thanks for the link. Only the Abstract is free for me; but I see it is not favorable to manipulation. Many other reviews have concluded that manipulation is simply as good as alternatives. In the past, chiros have claimed, and oversold, those reports as favoring chiro. In 1993 http://www.ncahf.org/nl/1993/9-10.html (bottom of page) one author remonstrated chiros for that. One of his points was that they studied “manipulation,” not chiro.

    In a study of manipulation followed by stroke http://www.ptjournal.org/cgi/content/full/79/1/50 spanning 1925-97, PTs were only implicated in 2% of the cases. According to Dr. Kinsinger, that is because PTs are more selective about use of neck manipulation and are better at it (not using a violent snap).

    When chiros point to good research showing manipulation as safe and effective for back pain as alternative treatments, the work usually is done by PTs, osteopaths or physiatrists. Moreover, chiros claim that they do “adjustments” (which explains why they cause more strokes). Circa 2003, the chiro board in Arkansas fined a PT $10,000 for performing an “adjustment” which they say is only permitted for chiros. The AK State Supreme Court upheld the fine.

    The chiro approach to “adjustments” vs. “manipulations” is schizophrenic.

  9. Nitpicking says:

    He offers to have me visit his practice, so that I can add my own anecdotal observations to the mix – missing the point that my anecdotal observations are no better than anyone else’s. How about some controlled clinical data?

    Would you be willing to work as an advisor with chiropractors who did, in fact, try to conduct a large, blinded, scientifically-valid study?

  10. Fifi says:

    “I have read on a number of occasions that frequent measurement of BP tends to lower it.”

    In some cases, it’s likely. Not all BP (do you mean back pain or blood pressure? I’m assuming BP) is create equal, and pain is a subjective experience after all (whether the primary source of the pain can be identified or not). There is a huge cultural and psychological component to the experience of pain, particularly chronic pain. Depression is a very common feature of chronic pain (and obviously can contribute to a downward spiral into deeper pain and depression). Some people who have chronic pain come from a very stoic culture and in some family cultures (and parts of society) being physically sick or disabled is the only context where taking a break and being cared for is acceptable. (This stoic attitude often contributed to the situation which set them up for, or caused, the chronic pain in the first place.) Naturally this can be a great source of tension within families and with friends who get sick of dealing with a grouchy, ungrateful, dependent person who has a condition that is only truly visible when acted out. (Not to mention that there’s often the subtext with chronic pain and mysterious ailments – from both the public and medical professionals – that people are “faking” it. Of course, sometimes people are but that’s usually a very conscious act and not the same as a potential neurotic component to how someone manages pain.) Physical and emotional pain are both pain, they’re both subjective, and they’re not as distinct as we tend to assume. So, the caring act and contact with a professional who is “doing” something can be reassuring on a number of levels and offer a “safe” environment for the patient (families can often become frustrated and abusive, we generally have very strong cultural beliefs about “manning up” or “working through pain”, which is at the root of many RSIs). Also, people tend to engage in better self care if they’re being watched over and monitored so they may well be better adhering to treatment guidelines. Sometimes the most understanding and compassion someone with chronic pain gets is in a medical context.

    Throw in the fact that often people get BP because we’re stressed from overwork – which for many people means either long hours doing repetitive actions or very long hours sitting and typing, neither of which tend to be great for the back. Also, one is probably getting less other exercise that might counteract the sitting, add some stress that interferes with sleep (and makes one more physically and emotionally sensitive), and you’ve got a good recipe for nagging lower back pain. This is an area where a little bit of prevention goes a long way since it is pretty much the only way to prevent a condition that generally can only be managed not “cured” (and is still, realistically speaking, an area of medicine that’s only really in its infancy). Which is not to say operations can’t sometimes help (but there’s some evidence that in some cases this may be the placebo effect in action again, such as the study that was done on a particular knee surgery).

  11. weing says:

    Congrats on an excellent and instructive post. Correct me if I’m wrong, but wouldn’t the ‘allopathy’ of Hannheman be what constitutes a lot of CAM nowadays?

  12. daedalus2u says:

    ” I also greatly enjoy sparring with those who have used logic and evidence to come to a different conclusion from me. A constructive discourse can only be a learning experience all around. I find I understand a topic much better after having to defend my position to someone adverse to it and who is using every argument they can muster to take it down.”

    I quite agree that my understanding get sharpened too by such arguments.

    I once worked for a man who often used rhetorical arguments and devils advocacy type discussions with me to try and sharpen my technical focus on solving specific problems. In explaining his management style to me, he used the analogy of the oyster, where it is the irritation from a grain of sand that causes the oyster to produce a pearl. He likened himself to the grain of sand and me to the oyster and what I would produce as a consequence of his irritation as the pearl. We actually got along quite well. His focus was on making sure there was a viable chain of facts and logic that supported the decision, because with that chain of facts and logic it was very likely to be a good decision. He didn’t have an agenda that a specific decision would be made.

  13. nwtk2007 says:

    I feel so celebrity now.

    One can review what I have presented and can pursue any search of available chiro research and see that there are good and bad studies, so pro and some con chiro.

    I have given up on presenting evidence here. Too much bias for objective review or even a good read and analysis. I guess you could cherry pick some and give that as an example. Even that would be more than has been done.

    Novella – “There was far more evidence for the safety and effectiveness of this drug than for chiropractic neck manipulation for any indication.”


    I am not sure but I would bet there is little correlation between treatment years for that drug and chiro treatment risks. If there is indeed none, then this is just another example of the bias seen here. I am not fully articulate on “treatment years” as it might apply to a physical medicine modality such as manipulation.

    I will soon.

    You could enlighten me. That would be a first. Or maybe a second. OK, I have learned a bit here on this blog. I’ll bite.

    Very busy now. I wish I had your time.

  14. nwtk2007 says:

    When I say “correlation”, I do mean “comparison”. Out of context and with different meaning, but I think you can get the gist of the statement.

  15. Abbs says:

    Every once in a while you see a report about somebody suffering a stroke after visiting a chiropractor. What you don’t hear about is the fact that just as many people suffer strokes after visiting their medical doctor. The reason…headache and neck pain are common first symptoms of stroke. When the patient goes to see their doctor, they are already in the early stages. A few days later, they suffer from more advanced stages. Chiropractors don’t cause strokes just like medical doctors don’t cause strokes. Cervical manipulation is a very safe and effective way to treat cervicogenic headaches and shouldn’t be discontinued just because some people have it out for chiropractors.

  16. Potter1000 says:

    nwtk2007: “Very busy now. I wish I had your time.”

    Funny. Yeah, Dr. Novella. Stop sitting on your ass all day doing nothing but writing bad things about poor chiropractors who can’t get a fair shake from scientists.

    I’ve got an ad hominem for you. nwtk2007 is an ass.

    Sorry for not contributing much to the conversation. It’s just that nwtk2007 is an ass, and I wanted to make sure everybody knew that.


  17. Joe says:

    Abbs on 18 Oct 2008 at 1:26 am wrote “Every once in a while you see a report about somebody suffering a stroke after visiting a chiropractor. What you don’t hear about is the fact that just as many people suffer strokes after visiting their medical doctor.”

    In fact, we have heard that. There is simply no data to support that claim. http://www.sciencebasedmedicine.org/?p=170

    Abbs on 18 Oct 2008 at 1:26 am wrote “The reason…headache and neck pain are common first symptoms of stroke. When the patient goes to see their doctor, they are already in the early stages.”

    To the extent that is true, why do chiros snap the necks of customers who have headache and neck pain??!

    Why do they whine (Dynamic Chiropractic, this year) about chiros who advertise that they won’t snap the customers’ necks? Sandra Nette was asymptomatic when the chiro ripped both of her vertebral arteries, and her doctor recognized that hallmark of chiropracty before being told it was a chiro.

    Also, health professionals (doctors, PTs) do not snap peoples’ necks as violently as chiros do. You can read about gentler mobilization at http://www.chirobase. org I have cited (above) the research that shows that chiros cause more strokes than PTs.

    Abbs on 18 Oct 2008 at 1:26 am wrote “Cervical manipulation is a very safe and effective way to treat cervicogenic headaches and shouldn’t be discontinued just because some people have it out for chiropractors.”

    Why is that claim never supported by reliable data? Wait, I know- there isn’t any. That notion only exists in the minds of people whose livelihood depends on it.

  18. daedalus2u says:

    I recently reread Feynman’s talk on cargo cult science


    and that is exactly what chiropractors are trying to practice. They are trying to go through the motions of science but without the content, without the understanding that they are trying to measure something about reality, rather than achieve something by going through a magic ritual. To them, the science of an RTC is indistinguishable from the magic of their chiropractic manipulations.

    No matter what results they achieve, they won’t modify their belief about reality.

    The only reason that science does work is that beliefs that do not work have been abandoned. If you are unwilling or unable to abandon your beliefs and practices, you are not doing science. If you can’t describe a hypothetical outcome of an experiment that would cause you to abandon your belief, then your belief is not based on science and is not a scientific belief.

    The anecdotes of people recovering following chiropractic manipulations are exactly the same as the anecdotes of planes landing with cargo after westerners built landing strips with control towers and populated them with radio operators. Thousands of planes landed on those landing strips. The number of successful anecdotes is very high. But when the natives built landing strips that were precise copies of the landing strips the westerners built, planes with cargo did not arrive except by chance and pilot error.

  19. mindme says:

    Abbs: Cervical manipulation is a very safe and effective way to treat cervicogenic headaches and shouldn’t be discontinued just because some people have it out for chiropractors.

    Really? Beyond merely asserting the truth of this, do you have scientific evidence of this? A recent ep of the quackcast did a lit review and I believe Dr. C. came to a very different conclusion based on the lit:


    Note quackwatch and the lit section:


  20. halincoh says:

    Anectdotes are just that – anectdotes: they are, as defined by dictionary.com ” a short account of a particular incident or event of an interesting or amusing nature, often biographical. ”

    And though a collection of anecdotes can, on occasion, stimulate idea formulation , which could generate a hypothesis, individually, they have nothing to do with science.

    In general, at least in the world of science, anecdotes are usually told to reinforce a preconceived ideology, be it traditional medicine ( I have countless tales of ineffective chiropractic results and homeopathic results and a few dangerous tales as well ) or in the alternative medicine world, they illustrate the imperfectness of traditional medicine. Rarely does an anecdote become significant to a biased mind if disagrees with one’s perception.

    The complexity of the human condition renders almost no treatment 100% effective. There is always a risk/benefit assessment in medicine. Science does this for us. The scientific method does not perfect medicine, it informs us regarding the biochemistry, pathophysiology, pharmocology, and effectiveness of treatment protocols, both new and established.

    These results are the building blocks we use to evolve as a collective science and as a medical model.

    Anecdotes, thankfully, are usually nothing more that self serving tidbits of UNTESTED information. They are great to make people laugh, scream, cry, or they may merely perplex, but rarely does one lead to a thought experiment ala Einstein.

    By the way, Einstein walked into a bar with a parrot on his shoulder and there at the bar were a rabbi, a priest and a minister … never mind … wrong kind of antecdote.

  21. alyric says:

    Abbs wrote:

    “What you don’t hear about is the fact that just as many people suffer strokes after visiting their medical doctor. The reason…headache and neck pain are common first symptoms of stroke. When the patient goes to see their doctor, they are already in the early stages. A few days later, they suffer from more advanced stages.”

    That being the case and since chiros as per your description are acutely aware of the differential diagnosis, they immediately send the patient to a real doctor for scans and such and perform no manipulation pending results, right?

    Apparently not.

    Dr Novella has already made this point on the original blog.

    Pottor 1000 you supply the ad hominem and nothing else. This isn’t PZ Myer’s where such is par for the course.

  22. LarryCoon says:

    In addition to what alyric very nicely said, there’s another fallacy going on here. A more extreme example would be if he had said, “more people die in an emergency room than in a chiro’s office.” Well, duh — more people are likely to seek real medical attention in the first place, especially with a condition that is life threatening. if “just as many” (Abbs’ words, not mine) suffer strokes after seeing the doctor, then the RATE of such strokes after seeing a chiro must be significantly higher.

    The real question, of course, is that for the person who IS in the early stages of a stroke, and might seek either medical attention or chiropractic attention, which choice is more likely to lead to a correct diagnosis and proper attention; and which is more likely to lead to a missed diagnosis and treatment that at best wastes time and at worst causes further damage?

    Abbs’ assertion that “just as many” (even if he didn’t really mean it that way) suffer strokes says nothing about whether chiros do additional damage to those suffering strokes, and says nothing about collateral damage they cause to people who aren’t suffering strokes.

  23. Abbs says:

    Why would a DC refer a patient to an MD just because they have a headache or neck pain when strokes happen just as often, if not more often, after a patient visits an MD. Obviously, the MDs aren’t doing a very good job of screening for strokes, either.

    Basically, you’re saying that you want a patient to be referred to an MD for some anti inflammatories instead of a safe and high quality chiropractic adjustment with a bit of soft tissue work, such as trigger point therapy and a little bit of massage? Because MDs don’t test for stroke when a patient presents with neck pain or headache. They prescribe extra strength ibuprofen without doing any kind of beneficial manual work.

  24. nwtk2007 says:

    Potter1000 – “Sorry for not contributing much to the conversation. It’s just that nwtk2007 is an ass, and I wanted to make sure everybody knew that.”

    Is the fact that I am rather busy make me an ass or is it my short response to Dr Novella’s post, which you haven’t addressed, that makes me an ass.

    I mean really. Is it a fair comparison the risk of stroke associated with manipulation and 75000 patient years of use of a medication? Can the comparison be meaningfully made?

    And if so, how does the risk compare to the risk associated with ibuprofen and other NSAIDS.

    You make a comparison of meds to stroke associated with manipulation. It seems you picked out a fairly innocuous example.

  25. Couple things – when someone presents to an MD with an acute headache they get a thorough neurological exam, which is a very good screen for a stroke. If the headache is acute and severe they may even get a CT scan of the brain and a lumbar puncture for spinal fluid analysis.

    You cannot dismiss the possible connection between neck and manipulation and stroke. Here is a good overview: http://www.sciencebasedmedicine.org/?p=94

    And don’t miss that there is no proven benefit for manipulation and headaches. There is some benefit for mechanical neck pain, but no better than simple mobilization – but no proven benefit for tension headache, migraine, or cervicogenic headache. A 2006 review ( J Orthop Sports Phys Ther. 2006 Mar;36(3):160-9.) noted: “There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH, CeH, and M in the last decade. In addition, the methodological quality of these papers is typically low.”

    Another review (Pain. 2004 Dec;112(3):381-8.) :”Therefore, we conclude that there is insufficient evidence to either support or refute the effectiveness of physiotherapy and (spinal) manipulation in patients with TTH.”

    And another (Clin J Pain. 2006 Mar-Apr;22(3):278-85.): “The authors found no rigorous evidence that manual therapies have a positive effect in the evolution of TTH.” TTH is tension type headache.

    I could not find any systematic reviews that showed evidence for efficacy. With no proven benefit, the risk is not justified. And risk aside – with no proven benefit, the treatment has no place in and standard care. If this were a drug it would not get approval.

  26. nwtk2007 says:

    I guess this is not the same thread that I gave some references to manipulation. And in practice as I have witnessed it, there is little difference between mobilization and manipulation, so evidence for one is evidence for the other. I have seen plenty and cannot see much difference if any.

    So any evidence for mobilization should apply to manipulation.

    As to the analysis of spinal fluid, what is it you would be looking for in particular. They measure glucose and protein and occasionally do a culture. If all are normal then what?

    I did analysis on hundreds of CSF’s and found very few that had abnormalities.

    So what next?

    Brain scans? Done plenty of those also. Only one abnormality and one mass out of literally thousands. ( The mass is in my daughters head by the way.)

    As a diversion, a friend of mine had a stroke. The CT was interpreted as normal and he was sent home. He got worse and the scan was sent to one of the radiologists we work with and he found the evidence of stroke. My friend returned to the hospital and was then taken in and treated.

    Just a side note I thought you might like to hear.

    He had had no manipulation in years. You think it might have been the chiro treatment he received in his years past?

    If this treatment protocol were a drug, would it also not have gotten approval? It IS the standard of care, true?

    I’ll check your references, but what of real life?

  27. nwtk2007 says:

    As to your reference, I am all too aware of this one.

    I thought for sure you were following it as have I.

    Didn’t you post on it?

  28. halincoh says:

    Abbs – I’m a DO, not an MD. I can and do do manual medicine. But it’s adjunctive to traditional medicine as used in my practice. I use manipulation much as a kinesiologist or physical therapist would. Why? Truth be told, I’m a hybrid: I am a DO who completed an allopathic ( MD ) residency. There is , in this modern world, minimal difference between an MDs training and a DOs training, primarily differentiated by knowing manual medicine techniques. Though philosophical differences are taught ( to different degrees depending on the DO school ) how they are put into practice varies greatly from individual to individual.

    The manipulation plays a very minor role in my practice ( and when I do so I tell the patients that it’s a transient fix or it may speed things up a bit, but it’s not a cure. If there is complete resolution it’s because of their body’s homeostasis , not my skills. Also, I ALWAYS rebuke chiropractic claims that manipulation or adjustments can do anything for non musculoskeletal issues. The pathophysiology just doesn’t render itself treatable by such magic. PLACEBOS do not count! When I manipulate a neck, 95% of the I use SAFE soft tissue techniques and when I do consider “cracking” I ALWAYS get a neck film first for exactly the reasons Dr Novella states. And if the person is elderly, they NEVER get “cracked” because the arteries in the region are more likely to be calcified and severe injury are theoretically possible.

    As physicians, we first must do no harm. Not only are some chiropractic approaches essentially malpractice as documented above, but harm is also rendered by misleading treatment or delayed efficacious treatment.

    A mother of a patient of mine refused vaccines years ago because her father was a ZEALOUS chiropracter ( there are conservative chiropracters who practice their skills sensibly I’ve discovered ). After her daughter became gravely ill from pertussis because of a combination of her unvaccinated state and her delayed seeking of appropriate treatment, she gladly embraced tradtional medicine.

    The above is only an anecdote, but it does exemplify the dangers of not being vaccinated and the dangers of inappropriate care; scientific research backs up the antecdote as Dr Novella as delineated.

  29. weing says:


    Regarding lumbar punctures in this situation. Sometimes you can find meningitis. I know I’ve found small subarachnoid hemorrhages that were missed on CT scans. Also we measure the opening pressure and can find and treat the headache of benign intracranial hypertension with the lp.

    Regarding your friend. Why would he have a stroke as a diversion? Anyway, I don’t know many tests that have 100% sensitivity. I also don’t know too many interpreters of CT scans with a 100% track record.

  30. Joe says:


    Didn’t it strike you as odd that nwtk claims to have done “analysis” of lumbar punctures; but was not sure why?

    I think daedalus2u has it right about “cargo cult science” (ex. Feynman*) where chiros go through a ceremony (without understanding why it doesn’t work for them). Or, as someone else has observed, they learn “conversational medicine” such that they toss out sciency-sounding terms, lacking comprehension of the meanings. For example, when cornered, they often say that Innate Intelligence is homeostasis; yet if you press them for reliable examples of where adjustments restore homeostasis, they fall silent.

    * Richard P. Feynman “The Pleasure of Finding Things Out” (Perseus, 1999).

  31. weing says:

    Yes, it did strike me as odd. It’s possible he went over lab reports of CSF analysis. I’m sure there is a logical explanation.

  32. kowari says:

    nwtk2007 – “And in practice as I have witnessed it…”


    You are still falling back on terrible, terrible subjective “evidence”.

    Why dont you understand that your OPINION on this is completely irrelevant to it being true? Just because you believe something you think you saw (yes, I say think, because our brains trick us into all kinds of things, I should know, I have MS and my brain thinks all kinds of weird things are true – HA see what I did there? Go me, argument from authority!!) does not make it objectively true or even correct! All the “evidence” you are providing is not scaleable, objective, or even mathematically useful input.

    Actually, why doesn’t EVERYONE realise that subjective truths are exactly that… subjective. Your brain lies to you ALL the time, give me evidence that does not rely on your brain (or equally on someone elses brain) nwtk2007 or on dodgey small scale mathematics/statistics.

  33. CSF analysis of someone with an acute headache, as has been pointed out now, is to rule out infection, subarachnoid bleed, and increased intracranial pressure.

    A CT scan within hours of a stroke is typically negative. Strokes don’t show up for a while. They are done to rule out bleed, not find strokes. Strokes only show up if they are massive, in which case the neurological exam will show them. A subtle stroke with a normal exam won’t show up on CT scan, but may show up on MRI.

    I pointed out imaging and CSF analysis because someone asked how strokes were ruled out by MD’s.

    You cannot change an anecdote into reliable evidence by relabeling it “real life”.

    There is evidence for manipulation for neck pain – not headaches. But the evidence also shows that the more gentle (and therefore probably safer) methods are as effective as more aggressive manipulation.

    NSAIDs have their own risk vs benefit analysis. They are safe when used properly. But they are problematic for comparisons because they are available over the counter, and many people use them improperly.

  34. nwtk2007 says:

    As pertains to the CT and stroke. It is the standard among radiologists and trauma physicians that CT is the imaging of choice as it is able to visualize fresh blood. This applies to the first 48 to 72 hours. After that time, an MRI is preferable in that it can visualize old blood and iscemic regions of the brain and it’s stem.

    In the case I referred to, the initial report was negative but when viewed by a neuroradiologist, it was clear.

    He was admitted and treated.

  35. nwtk2007 says:

    Novella – “there is evidence for manipulation for neck pain – not headaches. But the evidence also shows that the more gentle (and therefore probably safer) methods are as effective as more aggressive manipulation.”

    I had posted an article which had looked at manipulation for HA and the conclusion was that manipulation was at least as effective as Elavil for HA relief.

    At least now there is admission of evidence for neck pain relief with manipulation. What I don’t see is how you would differentiate between chiropractic manipulation and the “gentler” methods performed by, I suppose, PT’s. I have seen PT “mobilization” first hand and can see no difference between that and generic cervical manipulation as performed by chiro’s.

    Weing – “Regarding your friend. Why would he have a stroke as a diversion? ”

    Funny. I meant a diversion from the topic, but I see what you mean. I am certain he wishes he had had a “diversion” of a different sort.

    Novella – “You cannot change an anecdote into reliable evidence by relabeling it “real life”. ”

    But real life is what is important here and no study can substitute for that. It has been the “studies” in education that has lead, in part, to it’s demise; studies done by those not in the classroom, in the “real life” of education.

  36. Fifi says:

    kowari – The nature of bias and subjectivity, and the quirks of human cognition, have been explained to nwtk many times (as has why the studies he keeps representing aren’t reliable evidence). The thing is, as Daedalus pointed out, what nwtk is promoting is not science but the APPEARANCE that chiropractic is based in science when it’s really based on magical thinking. Each time nwtk gets one of the doctors here to engage with him as if chiro was based in science, he further creates the illusion that chiro is based in science, that the basic magical premises of chiro are scientific, and that it’s just rigid old scientists and doctors (you know, the kind who rely upon evidence and the scientific process) who are debating these caring, oppressed alternative practitioners. Nwtk doesn’t need to actually produce science and he’s not actually trying to convince scientists – he’s putting on a show of science to legitimize it. Like any con, it’s about contextualizing the con so it’s more believable (kind of like how it’s easy to impersonate someone in a uniform because people see the uniform but not the individual…science is the uniform, the evidence would be the individual in this analogy….these blogs keep providing him with that uniform, which is why he keeps making claims to authority, that’s what he’s really after).

    nwtk has repeatedly held up Parker College – which does seem to have helped chiro make inroads into the Texas medical system – as the best in chiro. They very clearly teach and promote the kinds of business and induction techniques used by Scientology, they even give awards to the person responsible for bringing Scientology methods into chiro. Nwtk’s objective here seems to be to try to get chiro’s magical thinking and pseudoscience accepted as science, and to promote chiros as being the same as medical professionals (when they’re really more like magicians going through ritualistic motions that look like medicine). I can certainly see why chiros would have set their sights on replacing or presenting themselves as primary care physicians – it’s actually a very effective strategy to take down medicine (the big enemy of both chiropractic and Scientology). It’s also why nwtk keeps floating these memes – it doesn’t matter if they’re true or not, he just wants to plant the seed and create the impression that chiro is an accepted medical modality and that only stuffy old scientists would object to it.

    It’s worth remembering that Parker College also pushes chiro “nutrition” which is essentially pushing over-priced, untested and controlled “supplements”. Big Supp is even more nefarious than Big Pharma because they very successfully lobbied the US government to prevent vitamins and supplements being regulated to ensure that the claims made in ads and on the label are accurate.

    It really is fascinating watching this kind of manipulation in action.

  37. nwtk2007 says:

    That is amazing FiFi, that you could get all that info from those articles I posted. I don’t remember any of them having anything to do with scientology.

    I don’t think you read anything of the kind and am willing to bet you haven’t read a single one of those studies I “sited”. (sarcasm)

    As you say, “fascinating” watching this kind of typical response by the anti-chiro fanatics. It is also a nice touch to bring in your take on “chiro nutrition”, as you put it, as if it is any different from non-chiro nutrition.

    I will say this, you are getting me interested in the Church of Scientology. I’ll give John a call and discuss it with him.

  38. nwtk – you keep insisting that we are not reading the studies you cite, but it seems your only evidence for this is that we disagree with you – even though we give valid reasons for doing so.

    Regarding the Elavil study – this is an utterly worthless study. Elavil as a preventive treatment for migraines often takes 1-2 months to titrate up to a therapeutic dose, and takes 6-8 weeks from that time to have it’s maximum effect. The treatment phase of the study was 6 weeks – not enough time for Elavil to have any beneficial effect in most patients. Also, the dose used in most patients was lower that what many patients need.

    Essentially, manipulation was compared to an ineffective treatment and found to be no different, which means that it is ineffective. There was a slight advantage to the Elavil toward the end of the study, which could mean that for some patients the Elavil was finally kicking in.

    I gave you three systematic reviews of the literature, you cherry picked one study that is, on close examination, worthless. You then hide behind poor quality data with anecdotes – more poor quality data.

  39. Fifi says:

    nwtk – I’ve gotten “all that info” (it isn’t very much info really!) from observing you and a bit of research into the institutions you refer to and promote. I find it fascinating to watch you practice these techniques and (sometimes quite successfully) engage people in your sham scientific dialogue that’s main purpose is to create the illusion of chiro being science. Now, obviously most scientists don’t just go through the motions of science like you do, so they do find it puzzling that you’re not actually interested in evidence but the appearance of evidence and keep playing by the rules of science and evidence when you’ve got a whole other game going (and winning is about getting them to engage with you and chiro as science, not actually providing conclusive evidence). I suspect many doctors and scientists who function with ethics and integrity have a hard time conceiving someone would not play by the rules or even consider evidence not really important. Pseudoscience is never about science, it’s always about creating the illusion of science (whether it’s Ramtha and What the bleep or chiros). Of course, in weaving this illusion incantory language is important (sciency sounding terminology, whether it’s borrowed from physics or medicine), as are physical rituals that appear medical (lots of “tests”, there’s a reason so many labs support CAM, it’s profitable for them to run useless tests), and the final step is always infiltration with the aim of control (presenting pseudoscientific research foundations, academia and then finally infiltrating actual science institutions). That’s why nwtk keeps going on about chiros in hospitals, he wants to create the illusion that the medical establishment and institutions accept chiros as equal to or superior to GPs (he’s changed his pitch from being that chiros are the same as PTs to chiros are the same as GPs).

    Since you claim to live in Texas and have repeatedly promoted Parker College as being the epitome of scientific chiro – it seems quite obvious that you support their methods…that is if you’re not actually working for Parker College. And, yes, chiropractic concepts of nutrition are outside of and different to clinical nutrition as taught and practiced within medicine. All one has to do is look at the curriculum at Parker College to see that really it’s just a front for Big Vita/Supp to spread disinformation and push product (just like ww.beatcancer.org is a front for JuicePlus).

    I’m merely anti-health fraud and pro people being able to make informed choices about their health – you’re the one who keeps bringing this blog back to discussions of chiropractic in the hopes that people will get sick of responding so you can just spam the thread with ritual exhibitions of pseudoscience you hope will make it look like you’re providing evidence. Since my area of expertize is communication, I’m particularly fascinated by how, where and why quacks are manipulating the message and why people buy into it. I’m also interested in how science and medicine can combat pseudoscience and quackery so understanding how you and your pro-chiro propagandists work is useful. Watching how you behave here has made it very clear to me that chiropractic is in bed with Big Vita/Supp, and engages in the same methods to recruit people to chiro schools (they’re at the top of chiropractic’s pyramid scheme), to pressure clients and to promote itself as Scientology does (Scientology promotes the same Big Vita/Supp myths about detox and nutrition as chiropractic does – which serve two purposes, to denigrate medicine and to sell shit that’s not medicine…increasingly reports of chiro/CAM trained “nutritionists” killing people through ignorance of basic biology are coming up, Scientology has long been known to kill people through their “detox” methods).

    Clearly there are chiros who don’t do this (and speak up against it) but you’re not one of them. Nor are you one of the chiros who have chosen to only practice things based in evidence and who are trying to clean up your profession (no doubt because they were lured into becoming chiros under false pretenses, such as chiropractic being based in science). In fact, you denigrate any chiro who does actually promote practice based on evidence! Once again, this merely reveals that you’re going through a ritual here when you present study titles as evidence.

  40. Fifi says:

    It’s worth noting that the whole CAM and chiro “nutritional” side is actually potentially more dangerous than the subluxation/manipulation/adjustment side for a number of reasons. (Though Big Vita/Supp is present throughout the hodge-podge that is the CAM pie, it seems to be particularly connected to and promoted by chiropractic colleges. That said, Big Vita/Supp seems to be a driving force behind the drive to integrate CAM into medicine by bankrolling things like http://www.beatcancer.org and providing nutritional “education” to both CAM practitioners and the general public, which promotes not only pseudoscience and serves as a source of disinformation but also is a form of stealth and not-so-stealth advertising). If you follow the money, you’ll find the trail leads back to Big Vita/Supp – whether you’re talking lobbying efforts to get rid of basic regulations that protect consumers or just the pseudoscientific sales pitches that people like nwtk keep trying to magically appear to be science.

  41. Fifi says:

    It’s also worth noting that Big Vita/Supp is also involved in the anti-vaccine movement. The ultimate aims are quite clear – to denigrate effective science based medicine so they can sell their product as the solution for everything (including autism) without actually having to be selling what they claim to be selling. It seems to me that Big Vita/Supp when teamed up with chiro is the source of a lot of pseudoscience and funds groups who denigrate science.

    There are a couple of strategies being employed. The obvious one is to attack science externally (a surface strategy which is about shaping public opinion). The secondary strategy (very effective so far apparently) is to infiltrate scientific and medical institutions so as to be able to destroy science from within and replace it with the appearance of science. There are a couple of distracting strategies being used to get people who want to defend science wasting their time and that ultimately work to weave the illusion that’s being sold that pseudoscience is science. One is to engage with doctors and scientists with a charade of presenting evidence – a hollow scientific ritual that frustrates people who do value evidence so is good as a provocative technique and, of course, provides the illusion that chiro (and chiro “nutrition”) is science and/or evidence based for those who aren’t literate in scientific methodology. Another, often employed by nwtk, is to claim authority without evidence of authority being provided (nwtk does this by claiming to be a science teacher/prof, to be the boss of MDs and PTs, by trying to pretend that chiros are merely the equivalent of PTs and MDs and do the same things, etc). There are all the regular fallacies and diversionary tactics such as erecting strawmen, tu coque (you’re a dick too) fallacies and so on. Conversely, when it’s clear that an appeal to authority isn’t working often there’s a retreat to an appeal of “authenticity” (as I’ll call it). Nwtk does this when he flips from claiming to be an authority on science and medicine to being “joe sixpack” and all this sciency insistence on scientific evidence is just too much for his good ole boy noggin and his claims to base his “evidence” in “real life” ’cause he’s just a simple guy, etc, etc).

  42. nwtk2007 says:

    FiFi, I have to hand it to you. You have nailed us down and exposed our, the chiropractic, conspiracy.

    We are devilishly clever. Thru nothing less than X-files tactics, stunning diversions and down right truths presented in such fashion as they could not possibly be deemed reasonable, we will prevail over medicine and it’s “we know it all, elitist” science.

    Us’ens down in good ole Texas are just a small fraction of the combined resistance.

    You have smelled us out girl friend. Launch all weapons.

  43. sonic says:

    I cannot tell you more about Chiropractic —
    So let’s talk about the real issues brought up in this post-

    From Dr. Novella’s blog-

    “Another consideration that must be added to anecdotal observations in generating hypotheses is plausibility. Not all ideas in science are equal. Prior probability is an important consideration in determining how scarce research resources should be allocated, and also in what experimental therapies to which it would be ethical to subject patients.”

    This is the Bayesian conception of data collection. We must have a prior probability in order to consider the new evidence. But where does the prior probability come from? At its worst, this is institutional bias. This can lead to a failure of scientists and non-scientists to accept new data.

    “A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it. ”
    Max Planck (earliest developer of modern physics)

    kowari says-

    “Actually, why doesn’t EVERYONE realise that subjective truths are exactly that… subjective. Your brain lies to you ALL the time, give me evidence that does not rely on your brain (or equally on someone elses brain) nwtk2007 or on dodgey small scale mathematics/statistics.”

    Actually why doesn’t everyone realize that all experiences are subjective? Did you have an objective experience? Did this ‘objective’ experience lead you to believe you had an ‘objective’ truth? How exactly did you come to the conclusion that you had this objective experience?
    Saying that someones brain lies to them all the time is nonsequitar-and you didn’t just read that, your brain lied to you…

    We often forget that science is a human endeavor and is therefore subject to the usual failings of human beings- we have only subjective experiences to base our thinking on, we are biased by our ‘prior probablities’, we can see things that agree with our basic philosophies much more easily than things that don’t, we are subject to the seven deadly sins. While it is true that following the scientific method is a good way of overcoming these shortfalls, we must remember that it does not change people into something other than human.

    We should realize that all experiments are run by people too. If you don’t think the data gets manipulated to make a point- you haven’t seen the experiments I have.

    Finally, and most importantly, all experiences are nothing more than anecdotal. And when it comes to healing and pain relief we should respect that the outcome of your personnal health and well being is the outcome you are going to care about the most. Calling someones personal recovery from a long lasting injury or pain an ‘anecdote’ is a tautology and is a silly means to try to get someone angry.

  44. CKava says:

    Where does prior probability come from? From logic and evidence. It is not ‘institutional bias’ to recognise, for instance, that due to the well understood properties of crystals their ability to heal people via ‘energy fields’ is non-existent. Or for a more appropriate example it is not ‘institutional bias’ to recognise that manipulating someone’s spine is very unlikely to effect their addiction to smoking.

    This is not to say that a low prior probability for a treatment completely rules out the possibility of a therapeutic effect. It does however mean that the burden of proof lies with those advocating the treatment. And with chiro the fact remains that the evidence is severely lacking for it’s efficacy in dealing with anything but back and neck problems and even then the evidence is hardly stunning.

    As for Max Planck’s quote he’s discussing a very real human foible (think of Einstein’s reluctance to accept Quantum physics) however it’s a foible that science as an endeavor is actually designed to overcome. As compelling evidence has been shown time and time again to inevitably trump authority. This same pattern is not reflected in CAM and certainly not in chiro in which there are still a significant no of folks clinging to a completely discredited model of how the human body functions.

    As for science being a human endeavor I don’t think anyone forgets that. In fact those who read this blog I would think are acutely aware that studies are for instance conducted by different groups with different levels of competency. You rightly point out that science is designed to try and overcome human bias however I think you downplay the significance this concept has for the topic of scientific medicine. Clinical trials are all about reducing the opportunity for bias to influence results and with chiro a disturbing pattern is clear. The better the study, the smaller the effect, to the point where the best studies of chiro treating things other than neck and back pain show no effect.

    It’s a redundant point that we all experience things subjectively. This is a fact no-one would dispute. However, most sensible people would dispute that this makes all conclusions based on subjective experiences valid. Particularly when it relates to healing. It’s only since we stopped regarding anecdotal experience as the best guide for what medical treatments work that we have seen the incredible medical and health advances of the past century or so.

  45. Fifi says:

    nwtk – Trying to pretend that it’s ridiculous that someone thinks you’re here with an agenda is ridiculous in it’s own right. The evidence is in your actions and obvious agenda (thanks for the really good laugh though 😉 ). I don’t think you’re engaged in a conspiracy, you’re obviously engaged in a con. You’re not “evil”, you’re just greedy and devoid of the basic ethics that most people take for granted. You continue to promote dangerous pseudoscience for profit and employ the kind of techniques Scientologists do, you’re from Texas and you hold up Parker School as the best there is in terms of chiro ethics and science education and they hold up a Scientology recruiter as their “chiropractor of the year”. That’s hardly a conspiracy, it’s pointing out the obvious connections and the way con men and controlling cults do business (and both Scientology and chiro were started by con men) and the connections between chiro and Scientology and the college you promote as being the most ethical chiro school.

    So don’t bother flattering yourself with ideas of being devilishly clever, you’re really just showing the kind of mundane greed, dishonesty and lack of empathy that any petty little con man does. Some people get conned by people like you because they have a hard time believing anyone would be so consciously shitty and dishonest – particularly someone presenting themselves as a medical doctor (that, of course, is part of the con because you’re NOT an MD). Like all con men, you’re manipulating people through their need and trust as a means to take advantage of them. The thing is, you’re just a lowly follower who’s following a script and perpetuating someone else’s con. It’s pretty safe to assume you’re pretty low on the totem poll if you’ve been assigned to troll the internets which is hardly where the clever evil masterminds are located within the pyramids of power.

  46. daedalus2u says:

    Sonic, wow, you have piled nonsequitor after nonsequitor. Scientists don’t reject data. Only denialists reject data. Millikan didn’t reject the data that (to virtually all physicists) proved the photoelectric quantum effect (after all, it was Millikan himself who generated that data). He rejected the idea that light was not a wave.

    The skeptics are not rejecting any reliable data that chiropractic works, there simply isn’t any reliable data that it does. Now that we understand a whole lot more about anatomy and physiology than they did 100 years ago, we understand why there is no reliable data that chiropractic works. There is no physiology to support it working.

  47. Fifi says:

    Sonic – You’ve just pointed out exactly why double blind studies which minimize bias and opportunity for bias are considered so superior to poorly designed and non-blinded studies. The difference between science and chiro though is that science is self critical while chiro, for the most part, isn’t. And, the small percentage of chiros that do speak up and advocate for a more ethical profession get attacked by the likes of nwtk and others.

    I really do feel sorry for people who just aren’t very medically literate who get conned into investing in a chiro “education”. They play lots of money – more than for a BA because chiro schools pretend to be a substitute for going to medical school – to go somewhere like Parker College where they’re taught pseudoscience by an institution and teachers who consider Scientology induction and sales tactics to be ethical for a health care professional! And then they get out into the world to find that anyone who’s scientifically literate recognizes they’re quacks and that they’re not qualified to work as MDs or embraced by those who practice real science and medicine. It’s sad because I’m sure quite a few well meaning people who’d make good healthcare professionals – maybe even MDs – get suckered into training for a career in chiro that’s based on conning people out of their cash via quackery and not helping and healing them as they first think. Of course, kind well-meaning people are often soft targets for a con.

  48. Joe says:

    Fifi, could you go here http://www.sciencebasedmedicine.org/ and suggest the scientology/chiro connection to Dr. Harriet Hall.

  49. Fifi says:

    Joe – I’ve been doing some superficial searches into it and, while it’s not exactly common public knowledge, it seems to be spoken about by both chiros who do truly desire to practice in an ethical manner and help people and ex-Scientologists who’ve broken with the script. It’s pretty interesting stuff.

    Until I ran across that Singer guy and his connection to WISE and Parker College, it didn’t really occur to me that chiropractic and Scientology were so intertwined. (Not that chiros are the only people Scientologists target, they’re just low hanging fruit since the two seem to have a very long history together and to have evolved from the same wacky roots!). For instance, I just discovered that a chiro invented the “e-meter” (a fine piece of cargo cult science in action!). Now that’s a wacky fact!

    Not surprisingly L. Ron Hubbard had a falling out with the chiro who invented it over money and control but they clearly were both working from the same pseudoscientific base. I’m now starting to wonder if Scientology actually lifted their methodology from chiro and not the other way around (since Hubbard wasn’t very original and did start out Scientology as a pseudoscience which he then turned into a religion for tax purposes).

  50. Fifi says:

    It really is all about following the money…. Here’s Dr Singer (the previously mentioned Scientologist chiro who teaches Scientology techniques and recruits for the org) teaming up with Big Vita/Supp to try to get (or should that be “scam”?) more of everyone’s insurance money. What a scam! This Singer guy’s all over chiro – even on boards that claim to police and regulate the very kinds of unethical practices he promotes as viable sales techniques! It seems that the guys almost running the whole chiro trade from the look of it.


  51. sonic says:

    I am not saying anything about Chiropractic. See my post.
    My comments about prior probabilities are well known problems to those who study Bayesian methods.
    The Max Planck quote applies because the problem has to do with what is considered a ‘plausable mechanism.’
    I agree that science is designed to overcome these difficulties- I just think that some people seem to think that it is more effective at doing so than is warranted. It is not the fault of science, but rather the fact that scientists are human. (See daedalus2u post for confirmation)
    My comments about subjective experience were specifically about what ‘kowari’ said, and I prefaced them for that purpose.

    You seemed to reject my statement that I wasn’t writing about Chiropractic.
    Who do you think Max Planck was talking about?

    It is not possible to do a double blind study in all cases. (The doctor preforming the surgery knows if he is doing a sham surgery or not).
    I agree that the double blind is the best experimental design when it is possible to use it. Just not always possible- darn!

  52. daedalus2u says:

    Sonic, the surgeon knows if he it doing a real or sham procedure, but the clinician who evaluates the outcomes can be blinded to which procedure the surgeon did. That is the whole point. Not everyone in the treatment chain needs to be blinded, only the patient and those who evaluate the results before the blinding is broken.

    Counter to your assertion, scientists never dismiss data because it doesn’t agree with their presuppositions. Scientists only reject data when it is unreliable which is sometimes very difficult to ascertain. Scientists only report unmanipulated data. If someone manipulates data, they are not a scientist, they are a fraud.

    Many times I have read papers where researchers had a hypothesis, took data to test that hypothesis and the data didn’t exactly fit what they were trying to show, but they put the data down as they got it. Nothing pleases me more than to have a hypothesis, look in the literature for research on that subject, find a paper where they did the experiment I was looking for, and find that the data fits my hypothesis better than it fits the hypothesis of the authors of the paper. That is exactly the kind of research integrity that Feynman was talking about. That is what makes science improve by progressive increments. I can rely on results that were done 30 years ago. There is still a lot of excellent data in the literature that is not fully understood. The understanding may change, the data won’t.

    I find actual manipulation of data to be quite rare. Often the conclusions don’t follow from the experiments that were done, and conclusions are made that are inconsistent with things that are well known (but apparently not to the authors).

  53. nwtk2007 says:

    Interpretation of data is always a matter of bias. The more unbiased one thinks they are, the more biased they become.

    A few years ago I heard a stat against drinking and driving which pointed out that from 6:30 pm on Friday to 6:30 pm on Sunday 80% of the drivers on the road had been drinking. And during that time, 60% of the accidents on the road involve a drinking driver.

    A drinker would say the non-drinking 20 % are getting more than their fair share of the accidents, causing 2 for one % more accidents than the drinkers whose % accidents is less than one of them.

    20% cause 40% where as 80% only cause 60%. It is worse if the accidents which involve drinkers involve only one drinker.

  54. Fifi says:

    nwtk – Wow, even the stats you try to present to prove your point are anecdotal! Once again, a superficial show of “science” that is rendered hollow since you are unwilling to acknowledge that your own beliefs about chiro based upon how you believe you’ve helped your clients who pay you is some form are biased.

    sonic – No one in science expects or claims it’s perfect, it’s only people into magic and woo that expect everything to be perfect and all loose ends tied up (and get all bent out of shape because science isn’t perfect). The reality is that the scientific method was designed exactly BECAUSE science recognizes that humans are biased and the method is designed to minimize bias. The fact that bias exists and is acknowledged in science doesn’t suddenly make all evidence equivalent (so just because bias exists it doesn’t mean that suddenly nwtk’s personal observations about his clients who pay him and his own work is of equivalent validity to a double blind study and should be accepted as such). If anything, it highlights just how important double blind studies are. There’s no reason that chiro should get some kind of special exception from evidence, despite the strawmen nwtk keeps erecting and you seem to be trying to rebuild from the ashes.

    Science searches for understanding with the knowledge that we’re still in the infancy of understanding our world. Science is about following those loose ends until we discover where they lead and what and why they do what they do or lead where they do or whatever they do or are. On the other hand, woo and pseudosciences/pseudoreligions claim to have total understanding of life, the universe and everything and peddle certainty (making people afraid so certainty is more appealing is an old gambit, used by politicians and other quacks for centuries). Peddling certainty usually involves ignoring reality and any annoying evidence that those loose ends lead somewhere or even matter (it’s often denying that there ARE loose ends). That’s why those most vulnerable to quackery and most often targeted by quacks are people with chronic diseases that currently have no cure or those who are vulnerable in some other way. That’s one of the big sell of quackery, that it can cure everything that is incurable (or indeed “cure” things that aren’t problems or illnesses in the first place and don’t exist to be “cured”). I, personally, always find it ironic when chiros and Big Vita/Supp push the “health freedom” meme since real freedom involves having the needed information to make an informed choice for oneself and all they do is lie. Of course, propaganda often involves this kind of double think.

    Now, I certainly don’t think all chiros are trying to or consciously perpetrating the kind of con or Scientology style tactics that nwtk keeps trying on here and that are promoted by Parker College and see to have been effective in Texas. (As noted before, it’s through ethical chiros that I even found out about the Scientology/chiro connection – well that and the Parker College/David Singer/WISE/Scientology connection!) I actually suspect that many people who get chiro “educations” are being conned by the nwtk’s of the world – certainly judging by the number of people who default on the student loans for chiro “educations”, it’s not a very successful education or profession (or chiro graduates are very short on integrity and long on greed and entitlement).

    #Note another ploy nwtk commonly employs, throwing in random unrelated stuff in a chatty kinda way to deflect and avoid. A common Scientology ploy is to pretend to be something one isn’t to lure in people so that they can work the script on them – nwtk does this both by trying to present himself and Parker College as an authority on science and medicine, and when that’s not going so well he goes with the “good ole boy” storytelling schtick which is equally lacking in authenticity but he thinks will play well with marks and make him appear friendly and harmless (maybe even a victim of the big bad scientists he comes here to troll, poor dear! 😉 )

  55. Fifi says:

    Sonic – Daedalus has already explained to you why the surgery study is double blinded and it doesn’t influence outcome. What you don’t seem to understand is that science doesn’t propose that individuals don’t have bias or that study design isn’t important – quite the opposite. So far, the only people on this blog claiming that their own very personal observations aren’t biased or should be considered “evidence” are chiropractors! The only people trying to slide past inherently and obviously biased studies as solid evidence are chiropractors! The only people trying to make excuses for shoddy biased trials are chiropractors!

    Sonic – If you personally want to discard the scientific method and say “screw evidence, it’s about faith” that’s your choice (as it is every individual’s, in my biased subjective opinion). My objection is to the con – trying to pass off pseudoscience as science, using unethical methods on susceptible people (you know, screwing over innocent people in need for personal profit by telling lies), and generally trying to distort science so con men can peddle pseudoscience. I object to this because it, in fact, destroys health and personal freedom by attempting to take away people’s ability to make informed choices about their own body and health.

  56. nwtk2007 says:

    FiFi, I love the way you “repetitively repeat” yourself, over and over again.

    I love the way you extrapolate from my having graduated from Parker that I have some relationship to scientology and some how have employed their practices into my own. You couldn’t possibly know anything of the kind and, in fact, I have described what I do and there is simply nothing like that in my practice or most.

    In fact, you extrapolate your narrow view of chiropractic onto all of chiropractic.

    This is YOUR con FiFi, employed by the “rabid” antichiro nutts out there who are a slave to their biases and unable to view chiropractic objectively. You make my case for me very well in many circles.

    I guess I should look to see what scientology actually is as I have never really been interested and the movie (the one with John Revolting) was too, too bad.

    I do find your accusations of screwing people for personal profit a bit insulting, but as I don’t do that, it is only mildly insulting. Whether I see a bunch or a few, I still make the same salary. And if I were removing subluxations I would agree about the pseudoscience accusation, but since I don’t then, once again, you totally miss the mark in flinging your insults.

    I really don’t think there is any aspect of my life that you haven’t insulted. But I am sure you are really nice on the inside and have a great personality.

  57. Fifi says:

    nwtk – Yep, just countering your communication strategy with a similar one. Though I clearly understand the method I’m using while you’re just following a script that you probably don’t even understand.

    I don’t think you’re a Scientologist (you may or may not be, no one here can know that based on your claims and I’m not claiming you are). What is obvious is that you endorse Parker College and have made numerous claims that it is the pinnacle of medical ethics and scientific chiropractic. Parker College holds up as their “chiropractor of the year” a Scientologist chiro who promotes a “business/sales model” that comes directly from Scientology and is connected to WISE, a Scientology org that’s explicit aim is recruitment. So, whether you’re a Scientologist or not you clearly endorse the methodology of Scientology since that’s what the school you endorse promotes. Whether you’re aware of this or have just been conned yourself is a moot point really. Of course, what Parker College teaches is all based around “innate energy” and correcting subluxations and you consider it the epitome of chiropractic ethics and science so all your claims to practice some non-woo based chiro are just more lies and attempts to paint yourself as a medical practitioner and a con man.

    #Note on nwtk’s strategy – Your attempt to position yourself as a victim once again is noted (and once again considered hilarious since you’re the chiro troll on a blog that supports science-based medicine who doesn’t deal in evidence, makes appeals for special exceptions for chiro, who promotes chiro colleges that consider Scientology sales and induction methods worth holding up as the epitome of chiropractic, etc).

  58. Fifi says:

    It should also be noted that nwtk constantly insults the authors of this blog, doctors, researchers and science and medicine in general and claims the authors here are money grubbing doers of evil. Yet he gets all twisted out of sorts and cries “victim!” when the connections between Scientology, Big Vita/Supp and the chiro college he promotes as being the epitome of science and ethics are pointed out. As usual, he’s proposing a double standard where chiropractors (himself in this case) and chiro should get special treatment.

  59. Fifi says:

    That should read…

    Of course, what Parker College teaches is all based around “innate energy” and correcting subluxations and you consider it the epitome of chiropractic ethics and science so all your claims to practice some non-woo based chiro are just more lies and attempts to paint yourself as a medical practitioner and not a con man (or a conned man unwittingly selling forward the con).

    This from Parker Colleges page on “what is chiropractic?”

    “The chiropractic adjustment is intended to remove any disruptions or distortions of this energy flow that may be caused by slight vertebral misalignments called subluxations. Chiropractors are trained to locate these subluxations and then to remove them to restore the normal flow of nerve energy, in terms of both quality and quantity….Chiropractic is based on the belief that the same innate intelligence that can grow a single cell into a complex human being, made of billions of cells, can also heal the body if it is free of disturbances to the nervous system.”


  60. Fifi says:

    I have no interest in converting people of faith or forcing medical treatment on adults who refuse it. I’m merely interested in science, medicine and communication and how to create a context so that people who value science and reality based thinking, and who want to make reality based decisions about their health, have access to accurate scientific information and are not being conned by people promoting pseudoscience as science. The authors here do an excellent job of explaining (and defending) science and the scientific method so there’s little need for me to add my voice in that area. In fact, their blogs are the primary reason I visit here. Playing with you and dissecting your methodology is a secondary reason (and not quite as much fun as it would be to just be talking science with people who value science but I accept that these days it’s rare to find a public area dedicated to science to do so that doesn’t have a resident nwtk-style troll and just have some fun…it’s often very informative for me, and hopefully occasionally for others).

  61. Joe says:


    Your con is supporting the quacks in your business. Despite the McDonald survey (cited, above) showing how quackery abounds in chiro, you say you don’t see it. You could at least say that you are shocked, shocked! to discover it.

    Despite claiming that you don’t have a subluxation-based business, and knowing that 90% of the people in your trade believe in it, you cannot find any fault chiros in general.

    You must also know about the repeat-business-building, and customer recruitment, aspects of chiro. Even if you don’t participate, it is a rampant, unacknowledged (by you) blot on your trade.

    You claim to provide rational treatment for your customers. We have no way of knowing this; the chiro degree certainly doesn’t provide a basis for doing so. You say that you help injured people- there are around 60,000 chiros who make the same claim. So, that’s no distinction.

    Finally, you claim that chiros are comparable to PTs; so research on PTs applies equally to chiros. That is belied by the study (cited, above) which shows that, over 72 years, chiro neck manipulation leads PTs 49:1 in causing strokes. I don’t call that “comparable” and neither should you.

    The question before us is not your, specific activities; it is the abysmal nature of chiropracty in general. Get over yourself, we don’t care.

  62. Fifi says:

    I think this is an appropriate place to quote nwtk back to himself since he seems to forget who he’s pretending to be and what he promotes….

    # nwtk2007on 01 Jul 2008 at 5:40 pm
    …I will agree that many chiropractors relate perceived subluxations to certain medical conditions which you would not agree are related, but even those chiropractors do not “treat” those conditions specifically.

    # nwtk2007on 01 Jul 2008 at 5:44 pm
    One additional note, most chiropractors who treat “subluxations” also treat with nutritional and herbal remedies as much or more as with manipulation. They focus on prevention and maintinance of health in a practical way, and not just through manipulation.

    These and more gems can be found here on the other chiro thread…


  63. sonic says:

    Fifi, daedalus2u,
    1) If you think I’m anti-science, you are misreading my posts badly.
    2) If a surgeon does a sham surgery, that surgeon knows. If he then sees the patient, that information can be passed to the patient unknowingly. If the surgeon does not see the patient after the surgery, then the protcol is not the same as usual surgery. It is this kind of difference between what you are testing and what you are trying to test that a trained experimentalist should be aware of.

    Fifi, if I told you that I know a couple dentists who have used things they learned from Scientologists to expand their practices, would you conclude that dentistry is a con?

  64. Fifi says:

    sonic – If you think you think you’re pro-science then you’re fooling yourself badly (or someone else has conned you).

    2-The very easy way out of the conundrum you don’t seem to be able to think your way out of is very simple. The surgeon doesn’t do follow up with any of the patients and doesn’t know beforehand who has which operation. It’s quite easy to create a believable excuse as to why another surgeon would be doing the follow up. Your objections are weak and poorly thought out – and certainly don’t lend any validity to your claims that chiro is just impossible to do studies on so should be held to the saem standards of evidence.

    3-I do believe that in science the term normally used is “researchers” not “experimentalists” (though no doubt in the world of woo “experimentalists” would probably fly quite well, it has that overwrought, archaic and grandiose ring to it that’s so popular in sCAM since it sound all magic and wizardly….I’m a level 4 Experimentalist with Super Elf powers! Shazaaam!!!).

    Actually there are other very good reasons to consider a lot of dentistry to essentially be a con in the sense that dentists often sell people services and products that don’t need, ditto for plastic surgery. Sure some dentists are very honest and stick to evidence based dentistry (for instance, my dentist advises against tooth whitening, particularly the instant version, because of how it destroys tooth enamel and erodes dental health…he’s not against cosmetic procedures, it’s just that his primary concern is dental health not cosmetic procedures). Some dentists actually are just as bad as chiros (dentists who drill out old fillings actually expose their patients to more mercury than leaving in old fillings, for instance….not surprisingly there’s a sCAM connection here….). So I think it’s quite valid to look at whether dentistry, as a profession, is ethical or runs the same kinds of cons which involve selling procedures that aren’t necessary and may actually damage health in the long run.

    I’d love it if SBM could find a dentist to bring on board to talk about the pseudoscience and quackery in dentistry!

  65. Fifi says:

    that should read….

    Your objections are weak and poorly thought out – and certainly don’t lend any validity to your claims that chiro is just impossible to do studies on so shouldn’t be held to the same standards of evidence.

  66. nwtk2007 says:

    FiFi – “It should also be noted that nwtk constantly insults the authors of this blog, doctors, researchers and science and medicine in general and claims the authors here are money grubbing doers of evil.”

    Just another example of your ability to extrapolate anything you want from my posts. Shwo me some examples of me”constantly insulting” the authors of this blog, or the researchers here, or the science here or the medicine here.

    I enjoy reading your BS but it’s incessant nature repetitive informational quality only helps to reinforce who and what you are.

    You are the classic ad hominem junkie, exposing me for what I am and what I must obviously do since you can be so verbose about it.

    I think you like me.

  67. sonic says:

    Where did I claim anything about chiropractic?
    You clearly have not read my posts with much care.
    I have not and never have made the claims you assert I have made.
    Why are you attacking me personally? Please stop.
    When I was in school at UCB, we called it ‘experimental design’. It is the term I see used repeatedly in write-ups of the experiments that I read on a regular basis. Is this an incorrect terminology?

  68. Fifi says:

    Nope, I’m here focusing on your communication strategies and techniques – I’m playing your game since you’re not playing by the rules of scientific discourse and evidence yourself I see no reason not to focus on what you ARE doing here. Much as I know you’d like me to stop pulling back the curtain to inspect the con as you try to enact it.

    As Joe noted, this isn’t about YOU it’s about the validity of chiropractic (unproven still, despite your constant presence here defending it). I don’t like or dislike you, why bother? I think you’re a con man (so probably reasonably charming and able to put up a front of caring in person), so I’d expect you to actually be quite likable (most con men are, it’s part of the con).

    Sonic – did you actually study experimental design or just attend UBC? You may be correct (though I stand by my opinion that it sounds like wooish term but then there are certainly scientists who get all excited about having fancy names too) and it may well be a term used in some areas of science. Having grown up around medical research and currently living with a researcher, I’ve never heard “experimentalist” used within the context of medical research. That said, I’m neither a researcher nor a scientist (though I have been an experimentalist on occasion 😉 ) so offer me up some examples and I’m open to learning a new term to add to the lexicon 🙂

    What you have continued to do is support the idea that a double blind study can’t be designed for surgery even though it’s been done. What you offer up as roadblocks to creating a double blind study for surgery are so silly that they seem more designed to support nwtk’s ongoing claim – that chiro shouldn’t have to provide evidence because it’s just too hard – than to be a serious discussion of study design (particularly if you’re claiming to be an expert in study design!).

  69. gdjsky01 says:

    I know Dr Novella said praise is boring. But his arguments are so easy to understand, yet are consistent. That’s what is really amazing. Post to post, podcast to podcast, his arguments make sense, and are consistent. He never has to resort to moving the goal posts or creating strawmen like his critics.

    Quite amazing and very educational. That’s of course what makes them so valuable.

    Making the world safe for science one quack at a time. 😀

  70. Abbs says:

    Wow! Why is everybody so nasty to each other on this site? Jeez, take a nap or something!

  71. Fifi says:

    Actually I’ve only had two regulars here actually be “nasty” to me on this blog – pec and nwtk who both only come here to denigrate science and medicine and promote pseudoscience – and I don’t take it personally but they do seem to get their knickers in a twist when their own techniques are used back on them.

  72. pec says:

    You get the prize for nastiness Fifi. And you admitted it yourself.

  73. mat alford says:

    Ooooh – there’s a prize?!! Pick me! Pick me!

  74. nwtk2007 says:

    Although I haven’t even read the last few posts yet, I am guessing that FiFi is attempting dish out what she thinks she has been getting.

    However, as to this last comment about “knickers” in a twist, I would challenge anyone who has been reading the past few days to see if they can tell by the writing who actually has their “panties in a bind” as we say here in Texas.

    I am not really sure as to why the other regular she referred to (I suppose it is Sonic) has her panties all in a bind also.

    And I wouldn’t call it nasty, I would call it bitchy.

    As to the double blind controversy, I have said, and stand by it, that physical medicine doesn’t lend itself well to double blind studies. It is a statement which does not imply that it cannot be done, it simply means that it is difficult with the introduction of so very many confounding factors.

    You have found one surgical double blind study and thus you imply that it apparently (notice I don’t say that you actually say it) is the standard of the effectivness of surgical techniques; and go on and on about it.

    Your refusal to accept the statement for what it is, once again, speaks volumes about your “true science” or as I should put it, “the true science of FiFi the “”married to a research scientist and an occasional experimentalist”” who knows all about science and it’s true nature”.

    Misquotes, twists of meaning, out right lies about what has been said and posted, endless extrapolations of meanings not meant and relationships non-existent just isn’t the nature of the pro-chiro group. I have found it to be very common among the rabid anti-chiro fanatics in their attempts to run their own agendas, or are just simply angry that they are proven wrong or that their thinking is somewhat amiss of the mark of a true scientist or that they ahve been exposed as a science elitist hypocrite and thus simply, as has been seen, have their panties in a wad.

    Sorry, I am now repeating myself and sounding much like Fifi and Joe.

    Tonight I will be rumenating (sp) thru a pig heart with my A & P class, identifying structures and discusing function/physiology. I will be concerning myself with true science and true science education. My students will, no doubt, be engrossed more than just a little (no pun intended) and challenged to regurgitate (sp) it back to me for review and reinforcement. They will invariably digest the info, absorbing the data/concepts/ideas and synthesizing new and better ways to view the circulatory system of the human animal.

    They will not twist what is taught or lie about it either. They will not extrapolate broad conclusions (incorrectly) from the material, nor will they insult the teacher or themselves for that matter. They will see neither hidden cons nor etherial conspiracies nor will they get their panties all in a bind.

    Got to go. I truly enjoy your very lengthy posts about, quite literally, nothing at all.

  75. Potter1000 says:

    Surely I should get some kind of prize for sinking to the level of calling nwtk an ass, right?

  76. Abbs says:

    nwtk seems alright to me. I think that everybody else just likes to hear themselves talk, ie the rambling “bitching” that is taking place on this board. Let’s end the attacks and talk about things of substance. I’m kinda getting sick of reading it all.

  77. Fifi says:

    Matt and Potter, I’d be happy to share 🙂 It seems that nwtk had to call in backup trolls so clearly he’s not so keen on both his tactics and promotion of Scientology-associated chiro schools as the epitome of chiro ethics and science be exposed. I feel so special that he’s throwing a little hate party just for me….though I do appreciate the irony of being told I’m “mean” by trolls.

    nwtk – You said it was impossible to do a double blind study for chiro because it was impossible to do it for surgery and PT. I provided evidence, you have still supplied nothing but excuses and avoidance tactics.

    Your assumption that I’m married to a research scientist because I live with one is off the mark – guess again. As I told you already, I don’t find your attempts to get personal upsetting since I see them for what they are – a bullying strategy that’s used by Scientologists (as is the group attempt to paint me as “mean” with little sockpuppet posse you’ve created).

    #troll strategy number 52
    Gather an army of sock puppets to go on about how “mean” someone is being to the troll (in real life these kinds of coercion tactics are an attempt to “break down” the target and incite an emotional reaction….hence nwtk’s assertions I’m angry when I’m not, he thinks it will make me angry! *lol*). Nwtk’s agenda has nothing to do with actual evidence and all to do with surface appearances, and is ultimately all about giving thet illusion that his pseudoscience is science (hence never playing by the rules of evidence while demanind everyone else do so) and he’s a trustworthy guy. Since he’s not actually trying to convince the science literate – who see through him anyway – nwtk’s strategy is designed with two major agendas. The aforementioned creation of the illusion that chiro is science by having it discussed by scientists and in science forums (even if the scientists can debunk the pseudoscience the aim is just the engagement to associate the ritual of science with chiro and chiropractors, it’s not in the evidence/details that the general public is less likely to understand.) The second is to be generally disruptive to scientific discourse while giving the illusion that he’s engaging in scientific discourse – the aim is to prevent people from engaging and learning the difference between science and pseudoscience.

  78. mindme says:

    nwtk2007: As to the double blind controversy, I have said, and stand by it, that physical medicine doesn’t lend itself well to double blind studies. It is a statement which does not imply that it cannot be done, it simply means that it is difficult with the introduction of so very many confounding factors.

    And yet as I pointed out, your neck manipulation study could easily have been blinded. I gave one dead obvious example. It would appear no chiro have ever thought to introduce such a basic control. Odd. No?

  79. nwtk2007 says:

    mindme, where is your post regarding your “dead obvious” example of blinding. I scrolled up thru this blog and nearly blew out a PIP joint with all of FiFi’s ranting.

    FiFi – I would also note your “unemotional” and not upset” mis-quote once again –

    “nwtk – You said it was impossible to do a double blind study for chiro because it was impossible to do it for surgery and PT.”

    I never said impossible and if I did I mis-spoke (you can find the post and prove me wrong). The continued twisting of my statements, lying about what I have said and implications that I some how am linked to, influenced by, altered by, effected by, practice like, or support scientology is bogus and a statement as to who and what YOU really are.

    As to mistakenly thinking you are married, well sorry. We have a thing down here called common law marriage. I would certainly not imply that you would have any allegiance to anything so trivial as some form of religious based commitment to another soul.

    I even admit to your 3 and 4 times stating that you have provided an example of a double blinded surgical study. My point is that there are very few as surgery doesn’t lend it self to double blinded studies for obvious ethical reasons. I would also suggest that it lends itself even more to double blinded studies as the subject is anesthetized either totally or in part (locally) and thus many confounding factors are eliminated, although not completely.

    In double blinded studies of physical modalities, the sham manipulation is very difficult if not, dare I say it, impossible. (Not saying it is impossible but suggesting that it might be extremely difficult. I mean really difficult.)

  80. Fifi says:

    I didn’t say all chiropractors supports Scientology, quite the opposite some take very real issue with Scientology and the cult’s techniques being used and promoted since they consider them unethical. What I said was that Parker College holds up a Scientology recruiter who teaches Scientology “business methods” as their “chiropractor of the year” (it was the “research” arm of Parker College that did this so this speaks even more strongly to the “science” or “sciencology” or some of pec’s “alternative science” that’s practiced at Parker College). You have continually promoted Parker College as the epitome of ethical and scientific chiropractic so clearly you have no issue with this obvious connection between Scientology and chiropractic – which makes your going through the ritualistic motions hoping to turn your pseudoscience into science even more obvious. (Since this is a technique equally used by Scientology in their other “medical” endeavors.)

    You’re statements haven’t been twisted, that’s just your lies and attempts to distract from the fact that you can’t support your claims with viable evidence happen to be obviously unravelling.

  81. Fifi says:

    nwtk – Your attempts to get personal and call me a “bitch” via your sockpuppet proxy duly noted as being entertaining and predictable tactics. Indeed, mirth and a fair amount of satisfaction does arise as I watch you engage with predictable tactics in an attempt to be upsetting (the satisfaction comes from how this affirms where you learned your tactics, whether you’re just a dupe repeating a script or aware of what you’re doing). You’re not very good at the personal thing though. Guess again about my relationship with the research scientist I live with ’cause you’re once again off the mark in your attempt to distract from the fact that you have no good evidence for chiro and are just putting on a ritual performance of engaging in science.

  82. mindme says:

    nwtk I was referring to my comments in the other blog posting thread:


    Oddly you commented on it. Let me repeat it here:

    ||Patients are randomly assigned. Chiros are not told of patient symptoms or complaints. No talking is allowed. Some chiros perform one form of manipulation. Some chiro perform the manipulation that supposedly has an effect on “cervicogenic headaches”.||

    It was in relation to this:


    INTERVENTION: After randomization, 28 of the group received high-velocity, low-amplitude cervical manipulation twice a week for 3 wk. The remaining 25 received low-level laser in the upper cervical region and deep friction massage (including trigger points) in the lower cervical/upper thoracic region, also twice a week for 3 wk.

    My problem is this experiment does not report how it controlled for the chiro’s own expectations. Does the chiro in the experimental group know what the patient is suffering from? Is he more caring and attentive? Does the chiro in the control group know he’s being asked to administer a treatment he believes is ineffective?

    The criticism about chiro and most CAM treatments is the herb or manipulation have no effect. The effect is purely placebo. A kind person in a white coat is providing placebo in both cases.

  83. Joe says:


    Also note that there are way too few customers, and too little significance (P barely below .05) in the study to lead to a concrete conclusion. It doesn’t rise to the threshold of a pilot study that supports calls for further research. And that is the best nwtk can offer after a century of claims for it.

    nwtk, can you say pathetic? I knew you could.

    Despite your claims about your own work, this is not about you. This is about cranks in your business. Your only involvement is your inability to see them, and your belief that high-school level research supports your fellow merchants.

    I don’t mean to disparage high-school science projects. I once helped a retarded 14-year-old with a project. When we got the result, he asked how we could know it is right.* nwtk- you, and your ilk, don’t have the perspicacity to ask that question.

    * So, we got an NMR spectrum to confirm his result. I would love to have been a fly on the wall when he showed his high-school teacher that spectrum.

  84. kowari says:

    Just have to say that this is fascinating. I am very amused that sonic missed the point of my comment about subjectivity… but that FiFi got it. I think I hit a nerve for sonic as they arced up so nicely about the topic!

    Yes, I was angling for the fact that anecdotal evidence is subjective and as such is not qualified to be used as evidence for any kind of theory. Sonic missed that point completely and accused me of a non-sequiteur then went off in some other direction which I followed for a while then gave up on as irrelevant.

    Anyway: The short version of my point is this – anecdotes (in which anyone says “I was cured of blah because someone did something unsubstantiated by evidence”) are subjective and are not useful in any way shape or form for the scientific method.

    Fact is objective and the scientific method self improves to eliminate any kind of human bias/subjectivity to come out with repeatable objective results.

    Thus far Chiropractic has nothing to offer us but anecdotes (I refuse to call them evidence for they are not), and nwtk has not provided anything more than that to support his claims and sonic has done nothing but obfuscate the argument with fluff.

    Let me reiterate and make it blazingly clear:
    Dr Novella has provided excellent argument and scientific evidence to back up his position. Nwtk has not provided anything more than anecdotes in support of chiropractic. Anecdotes are subjective no matter how “true” you think they are (because your brain lies to you) and thus are not qualified as evidence or any kind of proof until they can be shown in impartial scientific studies.

    Until either Nwtk or sonic provide something more substantial there really is no argument to be had.

    Guys – you have no facts, no evidence and no case! *shrug* That’s it, it really is that simple.

  85. nwtk2007 says:


    I provided ten studies in the other thread that FiFi has been ranting on and on in and though she says they are debunked, I have yet to see any one of them addressed. I think one study was brushed over a bit but very little of substance.

    I provided another double blinded study done in Italy and have had no comment yet.

    This study provided by mindme is one I had seen previously. I don’t think it stands up very well simply because it compares a thrust manipulation to laser and deep tissue massage. There is no sham manipulation which I think is needed to truly evaluate the thrust manipulation. You might as well compare the manipulation to a group walking in the park or weight lifting. It is meaningless except to say that the manipulation group had some improve ment. But as opposed to what? There is no chance to measure a placebo effect here although laser has no effect, deep tissue (trigger point) massage does but that is just a non-relevant point here.

    Here is the Italian study –

    Chiropractic manipulation in the treatment
    of acute back pain and sciatica with disc
    protrusion: a randomized double-blind
    clinical trial of active and simulated
    spinal manipulations.

    Santilli V, Beghi E, Finucci S.
    Direttore Cattedra Medicina Fisica e
    Riabilitativa, Universita di Roma “La
    Sapienza”, P.le Aldo Moro 5, Roma, 00185,

    BACKGROUND CONTEXT: Acute back pain and
    sciatica are major sources of disability.
    Many medical interventions are available,
    including manipulations, with conflicting
    results. PURPOSE: To assess the short- and
    long-term effects of spinal manipulations
    on acute back pain and sciatica with disc
    protrusion. STUDY DESIGN/SETTING:
    Randomized double-blind trial comparing
    active and simulated manipulations in
    rehabilitation medical centers in Rome and
    suburbs. PATIENT SAMPLE: 102 ambulatory
    patients with at least moderate pain on a
    visual analog scale for local pain (VAS1)
    and/or radiating pain (VAS2). OUTCOME
    MEASURES: Pain-free patients at end of
    treatment; treatment failure (proportion of
    patients stopping the assigned treatment
    for lack of effect on pain); number of days
    with no, mild, moderate, or severe pain;
    quality of life; number of days on
    nonsteroidal anti-inflammatory drugs;
    number of drug prescriptions; VAS1 and VAS2
    scores; quality of life and psychosocial
    findings; and reduction of disc protrusion
    on magnetic resonance imaging. METHODS:
    Manipulations or simulated manipulations
    were done 5 days per week by experienced
    chiropractors, with a number of sessions
    which depended on pain relief or up to a
    maximum of 20, using a rapid thrust
    technique. Patients were assessed at
    admission and at 15, 30, 45, 90, and 180
    days. At each visit, all indicators of pain
    relief were used. RESULTS: A total of 64
    men and 38 women aged 19-63 years were
    randomized to manipulations (53) or
    simulated manipulations (49). Manipulations
    appeared more effective on the basis of the
    percentage of pain-free cases (local pain
    28 vs. 6%; p

    At least in this case there are sham manipulations to compare to, but I have a hard time believing that a person would not know a sham from the real thing.

  86. kowari says:

    “At least in this case there are sham manipulations to compare to, but I have a hard time believing that a person would not know a sham from the real thing.”

    Precisely what I was going to say 🙂 it should be pretty obvious if someone is seriously massaging/stretching/doing anything to your back as opposed to someone who is just pretending. That would have a fairly high impact with regards the placebo effect as well which means that this study has dubious results at best. I would have to have more information on the “real” and “fake” manipulations to really be able to say with certainty however. But my gut leaning on this is… mmmm not really trustworthy as a test.

    I should probably point out here is something that I think people are missing and getting confused about. There is a difference between what I would dub “Back Physiotherapy” to improve back issues and the *cough* benefits of neck “manipulations” to cure cancer (as an extreme case).

    The Italian study you are referring to here seems to be much more in the former case than the latter, which is probably why there isn’t much comment on it. I am all for proper back physio therapy to treat spinal issues with a proper medical diagnosis, course of treatment and conclusion to said treatment. What I am calling “back Physio” follows scientific methods and process to achieve tangible, repeatable and measureable results.

  87. nwtk2007 says:

    kowari – “I am all for proper back physio therapy to treat spinal issues with a proper medical diagnosis, course of treatment and conclusion to said treatment. What I am calling “back Physio” follows scientific methods and process to achieve tangible, repeatable and measurable results.”

    I agree. Being in Texas a treating doctor in PI and W/C cases we have the responsibility for all of those aspects of spinal care. The results we get here are very repeatable and with documented tangibility; aka – resolution; not always to the pre-accident status but certainly to a reasonable MMI conclusion.

    I would add that in the case of neck injuries we have the very same results. I work with a good number of medicals but they prefer not to be on the diagnosis end of the treatment. Should I then conclude that they then, defer to my diagnosis as they will only evaluate and offer ancillary care to diagnosis that I have rendered? I ask in the light that they themselves accept the effectiveness of chiropractic care for the condition which I have referred for, specifically neck injury and manipulative care.

    They would not defer to me if they did not think that my diagnosis or treatment were ineffective. True?

  88. CKava says:

    nwtk2007> You still seem to be missing that no-one is disputing the fact that many medical doctors frequently endorse alternative treatments that lack evidence for efficacy.

    This still does not make the evidence for the treatment any better.

  89. Fifi says:

    strategy #372

    Here nwtk is once again trying to assert himself as an authority – this time as being more of an authority than an MD and we’re meant to take his word for it because, once again, he produces no evidence. (Quite hilariously, he’s asserting that MDs defer to him despite just recently claiming in the chiropractic lawsuit thread to not be sufficiently knowledgable in medicine to discuss it using medical terminology!)

    # nwtk2007on 24 Oct 2008 at 1:30 pm
    I wrote – “l notice that when backed into a corner nwtk likes to thrown out terminology to, once again, give the ritual appearance of doing medicine with the hope that those with little scientific knowledge will be flamboozled by the display”
    nwtk replied – “What a maroon. I hardly know any terminology. I don’t do medicine.”

    Of course, he’s still really trying to distract from the connections between Parker College (his alma mater and the chiro school he has repeatedly held up as being the best example of ethics and science in chiropractic), Scientology and Big Vita/Supp.

  90. nwtk2007 says:

    FiFi, you are a maroon if you think that anyone actually believed my terminology comment.

    Many chuckles indeed.

  91. Joe says:

    nwtk2007 on 24 Oct 2008 at 11:10 pm wrote “They would not defer to me if they did not think that my diagnosis or treatment were ineffective. True?”

    Not necessarily. They probably recognize that the complaint will resolve itself regardless of treatment. They figure “Why waste my time when the kid can waste his?”

    Really- where did you learn “diagnosis and treatment”? It certainly wasn’t in chiro school, most particularly the one you attended (courtesy of Fifi).

  92. kowari says:

    Sorry nwtk, I agree with Joe. There are some pretty awful MDs out there. Just because someone has the letters MD after their name does not make them smart. There are plenty of bat sheet crazy docs and terrible cranks to boot.

    You cant cite people referring you patients as some kind of argument from authority. That simply doesn’t hold water.

    So, my comment still stands – proper training for back physiotherapy is not chirpracty.

    Where do you stand nwtk? the chiropracty as invented by the Palmers or physiotherapy?

  93. Fifi says:

    Joe – Since nwtk has shown no evidence of his claims that there exists any MD anywhere who “defers” to the diagnosis of a chiropractor, it’s more likely he’s just making up more stuff yet again as part of the ritual performance.

    Anyway, all of this is to divert from the fact that he’s still presented no credible evidence for chiropractic and wants to divert attention away from the connections between his alma mater, Big Vita/Supp and Scientology.

  94. nwtk2007 says:

    kowari – “There are some pretty awful MDs out there.”

    You couldn’t be more right. Thus the huge number of deaths and the great amount of harm to the public done by their mistakes.

    The ones I work with are mostly orthopedic surgeons and a few GP’s who will actually see an accident victim or a work related injury and will not first need assurances that their bill will be paid for before seeing the patient. I find these types of doctors to be quite caring and helpful to patients.

    And sorry, you’ll get no “evidence” of what I am saying is true. As I have said before, their are too many crazy’s who would be a danger to anyone I might reveal. I won’t mention any names.

    Joe – “They figure “Why waste my time when the kid can waste his?”

    You honestly think that is true? Get real. Is that your panties showing or just your lack of experience. I know you mean to insult, else I would not have put it this way.

    Joe – “Really- where did you learn “diagnosis and treatment”? It certainly wasn’t in chiro school”

    You don’t really think doctors learn all there is that they know in school do you? Once again, get real.

  95. kowari says:

    You read my post but didn’t answer my question nwtk: Are you on the side of back pysiotherapy or Palmer theory?

    And just to make it clear: Back pysiotherapy = science, Palmer theory = pseudoscience. Where do you stand mate? There really is no inbetween. Either you believe the palmer stuff or you dont.

  96. Abbs says:

    You people would be surprised by the amount of pathology and various diagnostic courses that a chiropractic student takes.

    Here’s an example of the curriculum of one of the more science-based schools:


    Here’s a general comparison of the education between chiropractic school and medical school:


    And, by the way…there’s no such word as chiropracty! It’s chiropractic! Not chiropractics, either….chiropractic.

  97. Abbs says:

    Also note that Doctors of Chiropractic and Medical Doctors must pass the SAME basic science National Board Examinations!

  98. Joe says:

    Abbs on 26 Oct 2008 at 11:43 pm wrote “You people would be surprised by the amount of pathology and various diagnostic courses that a chiropractic student takes.”

    No, I am not surprised that they go to lengths to appear legit. It is the cargo-cult approach- trying to look like what you want and hoping to reap the benefits. The educational “paradigm” for chiropracty remains centered on subluxations and Innate http://www.chirocolleges.org/paradigm_scopet.html You don’t find health professionals wasting their time with those superstitions; they are strictly reserved for your cult.

    It also remains true that a DC can be licensed after seeing few (if any) people who have problems that need treatment http://www.chirobase.org as opposed to doctors who need years of clinical experience, with people who are ill, before they are licensed. Recently, some chiros sued their school for failing to provide appropriate clinical training. Although their complaint was true, the school won because it never promised to provide a legit clinic.

  99. Abbs says:

    I remind you, there’s no such word as chiropracty. If you’re going to argue against chiropractic, at least get the lingo correct.

    The study of chiropractic is chiropractic, not chiropracty, not chiropractics.

    So, are you saying that chiropractic science education is only superficial and that we don’t learn as much about the basic sciences as medical doctors?

  100. Joe says:

    Abbs on 27 Oct 2008 at 10:05 am asked “So, are you saying that chiropractic science education is only superficial and that we don’t learn as much about the basic sciences as medical doctors?”

    Considering that your own survey* showed that 9 out of 10 believe in subluxations, and 8 of 10 think subluxations are involved in visceral diseases- my affirmative answer to your question is well-supported. I had a student once who got a D in introductory chemistry (which is often considered a basic science). He asked me for a letter stating what his grade in just the lab portion was because he could still get into chiro school if he had a C in the lab! (I obliged his request.)

    Many chiros oppose vaccination. They would not do that if they were merely somewhat-educated in sciences.

    If that is not enough, peruse the silly magazines they call “peer-reviewed” and note what they think is definitive research (as has been cited here by nwtk). That stuff is not rejected by medical journals because of prejudice, it is rejected because it is rubbish.

    * “How chiropractors think and practice” William P. McDonald et al “Seminars in Integrative Medicine” 2004 V.2 #3 92-98

  101. Fifi says:

    Indeed, even nwtk doesn’t actually dismiss subluxations and admits it was taught at Parker College (even though he also denies that it is!)…


    # nwtk2007on 04 Jul 2008 at 4:12 pm
    “Chiropractic subluxation theory is only theoretical and as such is continually evolving and changing. When I was in school in the 90’s it was taught more as a motion restriction than as a “bone out of place” sort of thing. Obviously the motion of the joint will have tremendous impact on any associated structures and functions, including neurological structures…..

    ….What ever you would call these effects or changes has no bearing on the effects or changes themselves. It happens and it exists whether you say energy is released or allowed to flow or what ever. Being a molecular biologist prior to being a chiropractor and seeing the almost unbeieivable complexity and almost un-understandable nature of the genes and how they work to produce and guide the development of organisms, I have no problem understanding that we understand so little.”

  102. Abbs says:

    Considering that the basic sciences portion of the chiropractic national board exam is the same material as the basic sciences portion of the medical national board exam, and considering that some of the more scientifically oriented schools consistently have a first time pass rating upwards of the 90th percentile (higher than most medical schools), I’d say that for the most part the science education is adequate.

    Just because chiropractic schools don’t have the most strict admission policies doesn’t mean that they are a cake walk. If your student who got a D in general chemistry doesn’t change his study habits, he will never make it through chiropractic school and he definitely would never pass his part 1 board exams. I had a 3.4 GPA in undergrad with a mediocre amount of studying. I studied my butt off in chiropractic school to even come close to a 3.0. I never had to study anywhere close to that in undergrad.

  103. Joe says:

    Abbs on 27 Oct 2008 at 1:35 pm wrote “Considering that the basic sciences portion of the chiropractic national board exam is the same material [sic] as the basic sciences portion of the medical national board exam …”

    I see some wriggle-room here. For the sake of argument, I’ll posit the “material” is the same; but are the questions the same? Moreover, what are the standards for passing that portion of the test?

    Your faith in tests notwithstanding, you still have the insurmountable problem that most chiros, according to the survey I cited, harbor unscientific notions passed down from a grocer in 1895. That is what makes chiro a cult- you cannot deny your founder’s ignorant notions. The adherence, in practice, to those notions trumps your (dubious) claims that chiros have good, basic knowledge of science.

    Feel free to show us the reliable evidence that subluxations exist, and that they cause visceral disease, and that you can fix them.

  104. kowari says:

    Oh much LOL!
    Abbs:”I had a 3.4 GPA in undergrad with a mediocre amount of studying. I studied my butt off in chiropractic school to even come close to a 3.0″

    hmmm maybe because the undergrad stuff was logical and scientific and the chiropracty stuff is made up and illogical? Just putting the idea out there. It’s harder to learn stuff that doesn’t make sense.

    Palmer and his son made stuff up. THEY MADE IT UP! And after over 100 years there is ZERO proof of it working. None, nada zippo. Even the ether got smooshed out of Phsyics faster than that! Why? because the scientific process got it and proved that it didnt exist! (Go Michaelson and Morely).

    “Us People” are not surprised that there is science taught in chiropracty schools – that’s part of the pseudoscientific nature of it al. What we ARE surprised and extremely alarmed about is all the other garbage that gets taught as well! It isn’t the science component that is the issue here – it is the NON SCIENCE, pseudoscience, if you will, that is ALSO taught and is held as MORE true than the science (even when it contradicts it). That is the definition of pseudo science Abbs, and you are well and truly caught up in it. I beg you to take a step back and re-evaluate your situation and what you have been taught with a truly critical eye. Let go of your beliefs and REALLY look at what is there.

    Still waiting for your answer, mate. Gone suspiciously quiet… *frowns*

  105. nwtk2007 says:

    Sorry. I have been week end and work dead.

    I have been pretty clear about my position on the subluxation.

    I do not accept the subluxation theory and do not treat subluxations. I have even pointed out that I do not know, personally, any chiro’s who do. The chiro’s I know are involved in treating injuries or are in sports medicine treating sports injuries and related conditions.

    It is a bit more nebulous these days than the chiro schools are willing to admit, however. The subluxation hypothesis was not drilled into us as I have heard from the guys here that it apparently is at other schools. When it was mentioned at Parker in classroom subjects, in most but not all instances, it was the concept of malfunctioning joints, so to speak. Fixated joints were considered by many of the profs to be an example of a “subluxated” joint. We were also not taught or told that there are levels of the spine which correspond to organ systems or organic conditions. This was all out side the classroom information which some students subscribed to and many didn’t.

    Most of what we learned and practiced was physiotherapy. we learned to treat neck and back pain with manipulation, passive modalities and active modalities such as therapeutic exercises, deep tissue work, trigger point therapies, proprioceptive neuromuscular facilitation, various forms of stretching, passive and active mobilization, etc.

    So you can make up your own mind what you might think that I think based upon what I have said here and elsewhere in this blog and others.

    What seems to get people up in arms is that I do not totally dismiss the “outside” effect of manipulation or for that matter, of physiotherapy. In treating neck and back injuries I have seen changes in a few conditions not related to the injury such as asthma and Bp levels. It might be placebo effects but it would be an awful lot of placebo effect and I am not totally convinced a non-related change which occurs in a treatment for a neck or back injury would be considered a true placebo effect. I am not treating BP or even discuss BP with patients in any of the instances I have seen changes. Indeed, I don’t even get the chance to really see changes because I have insisted that patients with elevated Bp immediately see their PCP or another medical doctor for an evaluation to consider treatment of this condition. Obviously if they get the treatment by their PCP then I could not relate any of my treatment for their injury to any changes that I might see. (I monitor these cases and even go to the trouble of calling their doctor and putting them in the awkward position of absolutely have to get it taken care of.)

    I have also seen changes in patients asthma where they report using their inhalers less and less as they get treated.

    Who knows, really, at this point. It all needs more research and some well designed studies done in conjunction with other health care providers in the medical field. Current research does not support anything subluxation related, unless you look in the chiro journals, which no one outside chiro accepts. That in and of it self doesn’t mean the research is faulty or bogus. I just means that it hasn’t been really looked at that closely.

    So lets get this right. I do not think the subluxation is the key to treating non-musculoskeletal conditions nor it is a freeing up of the “innate energy” of the body to heal itself. I do not treat the subluxation, what ever that is. OK?

  106. nwtk2007 says:

    This is the short version. To me it is not as cut and dry as it is to some.

    As to the level of science education at a college like Parker (in support of Abbs), I will have to give it a thumbs up in the basic sciences department.

    I had a Masters degree in molecular biology when I had entered and had taught many years, at both high school level and college level, everything from physics, biology and chemistry. Based upon my experience at the time, I would rate it at least very good in the basic sciences which are intended to be a parallel to the basic sciences taught in the medical schools. And I had some experience there also so I had a fair grasp of the level of difficulty in the same course work in the med school as opposed to the chiro school.

    Of course the worry here is the pseudoscience.

    At Parker there was an assembly of the entire school once a week for guest speakers. Now, some of THEM were pretty far out there as was old man Parker himself. But my impression of the faculty was that they just tolerated him and his guest speakers and their incredible amount of BS they could come up with. But the BS was not a part of the curriculum in the extreme that one reading here would believe. And I would imagine that would be true for a lot of schools.

    At Abilene Christian University we had to go to chapel everyday. The material were subjected to in chapel was not a part of the curriculum there either. (Unless you were taking course work in bible.)

    And my view is, if you don’t hear both sides, then how can you make an intellegent decision about any of it?

  107. Joe says:


    Your stories prove nothing. That is why we say you (and most chiros) have an inadequate scientific background.

  108. Fifi says:

    Current Parker College beliefs about chiropractic as promoted on their website but denied by nwtk…

    “The chiropractic adjustment is intended to remove any disruptions or distortions of this energy flow that may be caused by slight vertebral misalignments called subluxations. Chiropractors are trained to locate these subluxations and then to remove them to restore the normal flow of nerve energy, in terms of both quality and quantity.

    The idea is that if the master system (the nervous system) is healthy and functioning well, then other systems under its control will also function in a more optimal fashion. Chiropractic is based on the belief that the same innate intelligence that can grow a single cell into a complex human being, made of billions of cells, can also heal the body if it is free of disturbances to the nervous system.

    For example, if the spinal area that supplies nerve flow to the stomach is subluxated, then information going to the brain regarding that organ and its function, digestion, will be distorted and the brain will not receive accurate data on its condition. Likewise, decisions made in the brain and conveyed along the nervous pathways will be disrupted and the correct responses cannot be made. It is essentially the same scenario for all other organs, muscles and blood vessels. When a chiropractor removes this interference, then the nervous system functions more optimally and the body is able to heal itself via the two-way communication system.

    The philosophy of chiropractic is that health, not merely the absence of symptoms, comes from within the body, not from the outside. It is the innate, or inborn, intelligence of our bodies that does the healing.”

    And a bit from chirobase about various chiropractic schools…


  109. nwtk2007 says:

    You quote philosophical jargon. Things are much different in many, if not most, practices, despite what “surveys” might suggest.

  110. Fifi says:

    I quote “philosophical jargon” from the site of your alma mater – Parker College. Parker College claims that what they teach is based on what you call “philosophical jargon”. You have presented no evidence for your claims that “things are different in many, if not most, practices”. You claim that they teach something other than they promote themselves as teaching and believing simply because you want to pretend they teach science not pseudoscience. (Teaching chiro seems to be much more profitable than actually being a chiropractor if one goes by the amount of loan defaults by chiropractic students – I can see why you’d want to pretend Parker College is science based and equal to a medical degree even though clearly it’s not, based on their own assertions about their beliefs of course).

    Joe has presented a survey done BY chiropractors regarding their beliefs. You have presented nothing except unsupported assertions and anecdotes you hope will make it appear as if you’re the equivalent of an MD or PT (even though the school you got your “education” from bases its concepts of anatomy and medicine on imaginary “subluxations” and “innate energy”…in other words, on magic thinking and philosophical jargon).

  111. Fifi says:

    You have still not addressed the fact that Parker College also holds up a Scientologist who fronts an organization intended to recruit for Scientology as their “chiropractor of the year”.

    Or the fact that a professor of “nutrition” at Parker College founded a notorious Scientology anti-medicine and anti-psychiatry organization and now runs a business that teaches people how to profit from selling supplements.

  112. nwtk2007 says:


    I only said the basics science program is very good and I base that on experience. Trying to convince you is a waste of time.

    Since you don’t have a clue either way, you are just talking out of your a$$, so to speak.

    You say – “you hope will make it appear as if you’re the equivalent of an MD or PT”, referring to me.

    I don’t need to appear equivalent and don’t need to make it appear that I am equivalant. I have simply stated the facts of the way it is as applies to me and many others, certainly not all.

    As to the Scientology connection you have repeatedly made note of, I cannot speak to that as I have no information about it, thus if I were to speakk of it I, myself, would be speaking out of my a$$. I don’t see any need.

  113. Joe says:

    nwtk2007 on 29 Oct 2008 at 1:40 pm “I only said the basics science program is very good and I base that on experience.”

    We have been through this, considering that you are a chiro you lack the science education to make such a judgment. Fifi has documented the school’s pseudoscientific bent. You did not notice it, I rest my case.

  114. Fifi says:

    It’s worth noting that nwtk contradicts his own claims about subluxation and what he was taught at Parker College.


    # nwtk2007on 04 Jul 2008 at 4:12 pm
    Chiropractic subluxation theory is only theoretical and as such is continually evolving and changing. When I was in school in the 90’s it was taught more as a motion restriction than as a “bone out of place” sort of thing. Obviously the motion of the joint will have tremendous impact on any associated structures and functions, including neurological structures. Physiological changes associated with movement are well documented but are also not fully understood or appreciated so we should not dismiss the “subluxation” theory quite so quickly.”

    And in the same thread…

    “But at Parker College in Dallas the “theory” of the “subluxation” was much more than just a vertebrae being “out of place”. In fact, we heard quite a few views of what the “subluxation” is or isn’t. The basic science guys would occasionally throw in some bits and pieces of anatomy, physiology and neurology that would, at least partially, substantiate or support some of the differing views of the “subluxation”.”

  115. nwtk2007 says:

    Joe – “We have been through this, considering that you are a chiro you lack the science education to make such a judgment. ”

    This is the part of your position that I find most amusing. Since you say we have been through this, then you know my background and that makes it an even more ludicrous statement.

  116. kowari says:

    Sorry, been sick, MS playing up.

    nwtk – “So you can make up your own mind what you might think that I think based upon what I have said here and elsewhere in this blog and others”

    Um… no, I asked you a question – do you believe in the palmer’s work or not? I try to make my own mind up based on fact, not deciding what other people think.

    You come very close to being skeptical, and scientific, and I would really like to believe that you DONT go in for all that malarkey, but the way you dodge questions, your general manner in which you dont QUITE answer the question at hand (very well done by the way) makes me think, yes, you HAVE bought into it and that you are trying to sound reasonable by telling us what we want to hear.

    Well, that isn’t what I want to hear. I want to hear you really and truly understand why we are concerned that chiropractic isnt a proper science! Why it should be thrown out and banned and anyone with serious intentions in the area forced to take proper courses with proper peer reviewed papers and journals that the whole science community can revel in!

    I want to hear that there will never be anyone perfectly healthy told to have “adjustments” as part of an unnecessary maintenance program and end up “locked in”. I want to hear that people in any medical capacity are trained to notice when a stroke is happening (or any other medical emergency for that matter) and that they know where to escalate the issue to.

    Mistakes happen, but chiropractic does not allow itself to deal with such mistakes. Swallow it up and accept it people!

    Take the post about the trial that Dr Novella recently posted as an example of how SCIENCE DEALS WITH NEGATIVE TRENDS FOR NO POSITIVE GAIN. Why should anything else be treated differently?

  117. nwtk2007 says:

    kowari – “Um… no, I asked you a question – do you believe in the palmer’s work or not? ”

    I thought I answered that back on 10/27/08 at 9:29pm.

    To clarify, I do not buy into Palmer’s work.

    I also will not be doing any “maintenance adjustments” and I think I can recognize when a stroke might be occurring. I have ordered enough brains scans (CT and MRI) to show that I am willing to take a look at S/S associated with both strokes and closed head injury as might pertain to potential concussion related trauma.

    I guess what confuses the skeptical zealots is that I don’t totally dismiss some possible connection between spinal mechanical function and “some” health problems. At this point I have been involved in literally 10 to 15 thousand cases which were primarily treated with physiotherapy and spinal manipulation and can, in all honesty, see intimations of a connection, however limited that connection might be. So I don’t totally dismiss the “subluxation” theory per say.

    I do, however, think that overall chiropractic education could be improved. Not by ramping up the course work as I have seen it, but by attracting a better class of student by requiring much more in the way of entrance requirements to the schools. I think chiro’s should be limited to treatment of spinal/musculoskeletal conditions and be banned from treating what are, at this time, unrelated conditions. Medicare should stop the requirement of a DC having to document on x-ray or otherwise a subluxation in order to treat a person for neck or back or shoulder or “what ever else” pain.

    DC’s should be required to screen adequately for the possibility of stroke or the potential of such (MD’s need to do the same by the way) and thus should not be deterred from ordering the proper tests to do so (ie – insurance companies refusing to pay for brain scans or refusing to pre-authorize the testing necessary for stroke and potential strokes to be ruled out). In fact, I think that DC licensing boards should mandate an upgrade in continuing education requirements to include updated education along these lines (Which some have done in the past but oh, so inadequately).

    That should be enough for now.

    Chiropractic as is practiced by some of us is good. Some chiro as practiced by the “chiro zealots” is bad. Simple enough?

    I must say though, that it bothers me to sometimes hear the pot call the kettle black.

  118. Cause and Effect says:

    I think that we are all missing a major point in the discussion…

    That for tens of thousands of years LIFE healed LIFE. But 150 or so year ago along came a medical profession stating that pills and fluids from the outside can heal the inside. Then 110 years or so ago along came a Chiropractic profession reminding us that LIFE heals.

    Over the course of time it has been a legalistic battle rather than a battle of service. One of process over truth and nickel and dime symantics rather than BIG ideas.

    There are within this one blog many anecdotes from both sides all of which are true. Anecdotes are LIFE. No different than saying “My sister rode a horse.” I went to my pediatrician as a child and was diagnosed with “incurable” asthma. I went to a Chiropractor and it went away. “Well, studies show that goes away in due time” is a common explanation. If that be the case, why not say so instead of giving a medication?

    “Because treatment is warranted and can help you feel better.” OK, I found that wasn’t the case. But it was with Chiropractic.

    Or my other favorite that I have heard from MDs I know “Mom won’t leave me alone unless I do something.” Isn’t telling her THE TRUTH doing something?

    “There is no “scientific evidence for that.” The last time I checked, LIFE didn’t happen in a scientific laboratory.

    I’ll paraphrase a colleague…Your pills don’t heal a body any more than my adjustments do, if you don’t believe me I’ll meet you at the morgue. You bring all your medications, I’ll bring all my adjustments and we’ll see who wins.

    That corpse is a physical body the same way you and I writing on this blog are physical bodies. What’s the difference? LIFE. Regardless of if we inundate ourselves with vernacular of Innate, spirit, God, electrical impulse, homeostasis, etc…we’re all humbled by LIFE. And without it, well….

    That’s what I see this blog’s discussants have forgotten…LIFE. It is all about proof, or in other words, ego…our own egos. It’s a high academia pissing contest complete with swearing. The only statement it is short of is “my daddy will beat up your daddy.”

    The last I checked, science was still about explaining LIFE. The how’s the what’s, etc. Medical science is about providing enough statistical data to support a treatment. And you all are arguing about Chiropractic? Last I checked, Chiropractic was about supporting LIFE.

    Besides, if what the medical profession has done was so helpful, people wouldn’t be seeking out Chiropractors or “alternative medicine.” They wouldn’t have to because they’d be getting healthy. THAT’S ALL THEY WANT…to be healthy. But that is what happens when you come from a business model…people vote with their feet.

    And you know what…THEY are what matter. The people we serve and are here to help. Not our studies, not our egos, not our schools in the media, not our name brand medications, not what adjustment cured MS…the people. And if we on this site were all here for the people, we’d be happy for them, regardless of what treatment option they chose when they get well.

    Some people it just takes time to learn what works for them…are they part of the 70% this study says “it” will help or the 30% that the study says “it” won’t. And on and on.


  119. Joe says:

    To paraphrase Cause and Effect on 11 Feb 2009 at 1:05 pm
    “I don’t have any evidence for the efficacy of chiropracty; but I can haz CAPITAL LETTERS!”

    C&E mentioned asthma and MS “cures;” but did not cite reliable evidence. There is no, reliable evidence. There is just chiro fantasy.

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