Middle Ear Infections and Chiropractic
Following our recent theme that chiropractic can help children, as reported by CBS News report on how chiropractic helps chronic ear infections.
There is more material like this at the:
Chiropractic and Otitis Media Page
You may wonder, how can chiropractic help reduce or eliminate that kind of infection? Great question! Read on.
Our nervous system controls the smooth muscles that move food through our digestive system, eggs from the ovaries to the uterus, and drain the middle ear into our throats, through something called peristaltic motion.
Subluxations of the upper cervical spine can slow, halt or even reverse this drainage of the middle ear, turning the eustachian tubes into a convenient transport mechanism for bacteria to colonize the middle ear. Considerable research has already demonstrated that antibiotics have minimal to no impact on otitis media.
The beauty is that chiropractic is very safe and has also been shown to be effective for relieving symptoms of chronic middle ear infections. When normal peristaltic motion is returned to the eustachian tubes, the middle ear drains again, and infections frequently stop. It’s just that simple!
This same mechanism also helps to explain why chiropractic has been found to be effective for improving female fertility and reducing the suffering of endometriosis.
I hope you will find all these pages of interest!
As somebody who’s suffered with ear infections my whole childhood, I wish somebody would have given my parents this information way back.
I find it interesting that of the 11 “Chiropractic Research Results for Otitis Media” that comes back under the “relieving symptoms” link, not a single item was for a controlled study.
Shown effective? how?
RESPONSE from Frank:
You seem to have ignored reading the 2nd listed article:
http://www.chiro.org/pediatrics/ABSTRACTS/Manipulation_Versus_Sham_for_Chronic_Otitis_media.shtml
Don’t worry, Dr Smith. It wouldn’t have made any difference. There not one jot of robust evidence that chiropractic is effective for otitis media. See (URL removed) for more information.
RESPONSE from Frank:
I guess that depends upon what you mean by robust. Are you a researcher yourself, or are you just another Blog critic?
As to the above coment on the research… an osteopathic manipulation and a chiropractic adjustment are like comparing apples to oranges. chiropractic is done with specific contoled thrusts in a specific line of drive to change/correct abnormal nerve pressure. An osteopathic manipulation is not done in a specific manner which can change the outcome/results.
Clinicly…. I see (like most chiropracTORS)ear infections go away after adjusting, even after rounds of antibiotics did not help. Did I cure them?…. NO! I removed the interference to the nerve system and the body healed itself. That’s enough evidence for the parents and the kids.
Well I had otitis media as a child, didn’t have chiropractic, and it got better. That’s just as good a proof that chiropractic doesn’t work as your individual experience is proof that it does.
RESPONSE from Frank:
I had recurrent ear infections throughout childhood, as did many children. The issue is not whether the body’s mechanisms may eventually defeat infection…the issue is the unnecessary suffering we both experienced. Perhaps you failed to note the low level of recurrence in the children who received chiropractic care?
Even in observational studies like these, if the “natural history” of a disease is disrupted by an “unconventional” treatment, that is important (BIG) news. Validating that with a randomized study is only adding frosting to the cake.
Kevin: you have ‘explained’ what you think the intended outcome of chiro and osteo manipulations are, but this doesn’t really explain anything at all.
This ‘specific’ word is interesting – chiros use it all the time. But what does it actually mean?
Since ear infections will generally clear up all by themselves (with or without antibiotics, chiro or osteo) how can we know that any adjustment had anything to do with it?
Response from Frank:
Joe
The term specific evolved because some of the schools that opened after Palmer taught very generic and unsophisticated forms of manipulation, so Palmer grads adopted the term specific to differentiate themselved from the wanna-bes.
Then later on, when BJ Palmer first developed the HIO (upper cervical) technique, he called that specific as well.
One other wrench to throw in, if you can remove subluxation with an adjustment, you could conceivably cause a subluxation adjusting an asymptomatic patient. If that is the case, where are the reports of sudden ear infections or bedwetting following and adjustment.
RESPONSE from Frank:
Interesting question. Do you doubt whether applying a force to a healthy cervical segment could cause viscero-somatic responses or symptoms? Really?
These are all wonderful thoughts and questions. The scientific method is based on observation. If I sneeze and there’s a car accident across the street, we do not know if there is a relationship between the events. We can sneeze a 100 times and count the accidents. That’s observation. And all of us must agree that even if there were 100 accidents, it still wouldn’t “prove” (or disprove) the relationship. However, case studies report on doctor’s observations. And those observations lead researchers to design trials.
I’d like to direct you to a few articles that may help you to understand my thinking on the mechanism of spinal subluxation, and the mechanisms that cause otitis media or endometriosis. If you have an argument, then please direct them towards these papers. Refute the logic and science of these papers, and I’ll reconsider my thinking. Just click on the journal links, and it will take you to right to the primary sources. Figure 4 in particular details how subluxation symptoms can be misconstrued as visceral disease.
1. Somatic Dysfunction and the Phenomenon of Visceral Disease Simulation: A Probable Explanation for the Apparent Effectiveness of Somatic Therapy in Patients Presumed to be Suffering from True Visceral Disease
J Manipulative Physiol Ther 1995 (Jul); 18 (6): 379–397
2. Endometriosis and the Anterior Coccyx: Observations on Five Cases
PCC Research Forum 1985 (Summer); 1 (4): 120–122
While we lack RTC’s, I’ve personally experienced improvements with otitis media via chiropractic adjustments with my patients as well as with myself!
It has to be asked why there are no RCTs that demonstrate the apparent efficacy of chiro for ear infections, why the best trials that have been done do not show any efficacy for chiro and why personal anecdotes are thought to be a substitute for them?
RESPONSE from Frank:
First off, you claim that “the best trials that have been done do not show any efficacy for chiro”
MY RESPONSE: HOGWASH! Please share these “best trials” with us.
Second off, as to the darth of controlled studies, the short answer is money, Joe. The only Federal research money (NIH) ever appropriated for an otitis media study was granted to an MD (David Eisenberg) about 4 (or more) years ago…but the project was shelved before completion.
Other than a few million, mostly devoted by NIH to help our profession improve infrastructure at Palmer’s Research Center (in Davenport) virtually every penny of research money spent on chiropractic trials was paid for by our profession (up until the early-2000s). Just name ONE medical trial paid for by their profession? All that money came from the NIH or from drug companies.
If you’d like to see us run trials, are you prepared to pony up the cash, or write to Congress about why in the NIH budget (well over $20 BILLION) that the funds devoted to ALL forms of Alt-Med is less than one tenth of one percent of their budget?
If Eisenberg is to be believed, more people now seek alt-med than seek ANY other form of medical treatment. Based on that fact alone, shouldn’t a larger piece of the research pie go towards alt-med, to demonstrate it’s benefits OR drawbacks? Wouldn’t THAT be the rational, scientific thing to do?
We are fighting an upward battle when it comes to research, but we are fighting a battle worth fighting. It’s bad enough we have sceptic outside our our profession, but to make matters even worse, we aim and shoot inward from our own profession. I too have seen many children with ear infections thrive under Chiropractic care. My assumption based upon my education and experience is that removing nerve interference has a positive effect on this outcome.
The principal complaints I have seen relate to the lack of randomized, blinded, comparision trials. This is voiced by that portion of the profession which I call the “don’t-rock-the-boat” faction, those well-meaning science buffs who’d prefer we stuck to what’s already well-supported in the literature (LBP). UGH!
Anthony Rosner, PhD (former research director for the FCER) has written extensively about the drawbacks of this flawed thinking process. His most recent piece is titled “Great Expectations in Randomization, or “I Was an RCT Dropout”“. Our Problems with Placebos Page documents other aspects of the issue. In particular, please review this FULL-TEXT article by Dr. Rosner.
I’m all for science, don’t get me wrong. But lack of numerous studies does NOT translate to lack of efficacy. It just means we have more work to do to explain how chiropractic helps these conditions.
Check out the Conditions That Respond Well to Chiropractic to review what literature we do have, supporting the benefits of chiropractic care.
I may wonder, how can chiropractic help reduce or eliminate that kind of infection?
RESPONSE from Frank:
I believe the principal mechanism is that Upper cervical adjusting seems to improve drainage of the middle ear via improved or increased peristalsis.
Ignoring the NIH budget (because it is irrelevant), just how many chiropractors are there and how much money are they making from the public? And they are doing that all without any decent evidence? Is that ethical? Shouldn’t some priorities be sorted out here?
RESPONSE from Frank:
Joe,
You’re the one who “claims” that he wants to see MORE research, and since the NIH is THE primary funder for Research in this Country, how could you possibly refer to it as “irrelevant”? That’s where the money for research comes from.
As for how many DCs there are, or how much they make, what business is that of yours? How much do YOU make, and how much does YOUR work contribute to the Nation’s health? I think you overstep yourself, sir.
According to Dr. Richard Smith, editor of the prestigious British Medical Journal, only 15% of all medical interventions are supported by, solid scientific evidence. [1] Whereas, spinal adjusting/manipulation has a significant body of research suggesting that it is effective (and cost-effective) for a variety of conditions, and that it is also AT LEAST AS EFFECTIVE as most medical nostrums, applied to the SAME EXACT COMPLAINTS.
To quote the bible, why lecture us about the mote in our eye, while you ignore the beam in theirs?
1. Where is the Wisdom? The Poverty of Medical Evidence
British Medical Journal 1991 (Oct 5); 303: 798–799
I’ve always found that the people that there will never be enough evidence for some people. EVER.
The amount of success that I’ve had in my office(yes I know it’s not a controlled scientific study) is in the 99% success rate. Specifically, parents bringing in children with 3+ ear infections, usually diagnosed within days of bringing them in. We end up being the last resort before the next round of antibiotics or the good old tubes procedure.
There has been only one child that adjustments did not help with, and the poor kid needed a surgery to fix some structural limitations he had. Bummed me out.
It is too bad that some of the posters had to suffer as a kid, but it is not a fluke or coincidence after seeing successful resolutions with an MD’s verification within days.
Joe posts:
>>”December 10th, 2009 at 6:07 pm
Ignoring the NIH budget (because it is irrelevant), just how many chiropractors are there
and how much money are they making from the public? And they are doing that all without any
decent evidence? Is that ethical? Shouldn’t some priorities be sorted out here?”<<
Yes— some priorities DO indeed need to be "sorted out here"!
You ask: "how much money are they making from the public?" Perhaps a better, realistic, genuine question would be: "how much money are they saving the public?". There is an entire section here on the cost-effectiveness of chiropractic treatment, plus, be sure to read this most recently published report:
http://images.vortala.com/chiropractor/USA/California/Carmichael/Foundation%20for%20Chiropractic%20Progress/SiteGraphics/ChiropracticServicesReport.pdf
Do Chiropractic Physician Services for Treatment of Low Back and Neck Pain Improve the Value of Health Benefit Plans?
An Evidence-based Assessment of Incremental Impact on Population Health and Total Health Care Spending
Nene,
Let me know when the AMA or pharmaceutical company wants to throw a few million towards a controlled double blind study on ear infections. It obviously isn’t in their best interest financially, as the anecdotal evidence/claims have been around long enough to investigate it through a trial.
I’ve accepted the fact that I am helping a large number of children who have have chronic ear infects, as well as acute. By the way, I am not taking credit, interference was removed from their system, and the body self-regulated the way it was supposed to.
As far as making a ton of money of these situations, we see children under 16 free of charge, and when compared to many of the standards protocols used for many medical procedures, chiropractors are a red herring when it comes to cost overrruns/fraud.
I get the feeling you are more interested in arguing about science all day, but it wouldn’t take much to find out how false so manys studies Big Pharma has put out or doctored to get treatments approved. These have raked in BILLIONS of dollars on delayed results. IMAGINE IF A CHIROPRACTOR DID THIS. Here is a snippet of an article:
“Vytorin Controversy
A new study published in the New England Journal of Medicine in November 2009, reported that Abbott Laboratories’ (ABT | Quote | Chart | News | PowerRating) Niaspan (Niacin Extended-Release) worked significantly better than Merck’s cholesterol drugs Vytorin and Zetia in reducing arterial blockages. The study dubbed ARBITER 6 – HALTS was a head-to-head comparison of Niaspan and Zetia conducted on 208 patients at high cardiovascular risk.
However, Merck says that the results of the study do not in any way change its view of Zetia and Vytorin as effective medicines for fighting high LDL cholesterol. According to Merck, patients in ARBITER-6 were extensively pre-treated with statins, and had well controlled LDL but relatively low HDL, which is a study design that strongly favors a drug with Niaspan’s effects on HDL over an LDL-focused medicine such as Zetia. Moreover, the company is of the view that the study does not have the rigor or size to provide meaningful insight into the effect of either Niaspan or Zetia on clinical outcomes.
Vytorin is a one-pill combination of Merck’s Zocor, a statin, which is now available in generic version, and a non-statin called Zetia, developed by Schering-Plough and co-marketed by Merck. Vytorin was approved by the FDA in 2004. Zocor lost exclusivity in June 2006.
The combined sales of Vytorin and Zetia, have taken a hit ever since the results of a study dubbed ENHANCE revealed in January 2008 that though Vytorin lowers bad LDL cholesterol, it did not provide any significant benefit over generic Zocor in reducing the risk of heart disease or stroke.
The combined global sales of Vytorin and Zetia were $1.0 billion for the third quarter of 2009, representing a 7% decline compared with the third quarter of 2008.
The ENHANCE study was completed in 2006, but the results were revealed only in 2008. The conduct of Merck and Schering-Plough in promoting Vytorin and delaying the release of trial results were probed by the U.S. Department of Justice.
In August of this year, Merck, Schering-Plough and the companies’ cholesterol joint venture, Merck/Schering-Plough Pharmaceuticals, entered into agreements to resolve pending civil class action lawsuits related to cholesterol drugs Vytorin and Zetia for a fixed amount of $41.5 million. The charges were recorded by the joint venture, Merck/Schering-Plough Pharmaceuticals
in the second quarter 2009.
The agreements are not an admission by the companies of any misconduct or liability in connection with the marketing or sale of Vytorin and Zetia or plaintiffs’ allegations relating to the ENHANCE study.”
Notice the timing and amount of money we are talking about? What they don’t mention, and you can find in other articles is that one drug didn’t DO ANYTHING, and the other lowered the incidence of plaque by a measly 2%…to the tune of $1,000,000,000 ($ 1 Billion) earnings in the third quarter of 2009!
Who is stealing from who? If you care about statistics so much, why not concentrate on the real thieves, and let the people who are preventing problems, such as Chiropractors, do their job.
To paraphrase: “Big Pharma don’t have sound evidence for everything they do, so why should chiros bother?” Is that a fair summary?
If so, it is a facile argument. “Some people steal, therefore it’s OK for us to steal.” “Some people kill, so it’s OK for us to kill.”
We’re talking about taking money from people who may have serious medical conditions. Is that kind of attitude good enough? Don’t you think people deserve better? If chiropractic has no good, repeatable, independent evidence that it is effective, then would you not class chiropractors as behaving unethically?
(BTW, the figure for treatments that don’t have good RCT data as evidence is more like 80%, not 15%.)
Joe,
Do you honestly think that’s what I meant? My point was that there is plenty of individual, yes anecdotal evidence, of the effectiveness of the resolution of ear infections through chiropractic adjustments.
It really is too bad that Chiropractic doesn’t have the support from our members, or the huge money Big Pharma provides for research, or else we would have more controlled studies that you are asking for. Big Pharma and the AMA have zero reason to promote or support researching to see how chiropractic is successful in helping peoples bodies heal.
How would this help the drug and surgery industry??? Unfortunately, they are the 400lbs gorilla.
I brought up the example of the cholesterol lowering drugs, to show you how flawed the research currently is, and it’s DIRECTLY costing people multi billions a year for just 2 drugs. It is doubtful the same people complaining about lack of research are on Big Pharma boards railing about Big Pharma stealing billions.
Lack of research and research funs are Chiropractics main issues when making these claims, beyond the the in practice observations(that more then justify the need for a grant for a large study to be done.) As a group we are not avoiding research, but the cost of it isn’t in the budget of most of our offices. Our associations are more then likely spending these funds on defending our profession against naysayers.
I, personally, get enough evidence in my office everyday to know that the body heals itself when the nervous system is functioning without interference. Your mind and body might have more confidence in the medical system and thats fine.
When analyzed closely enough, there are far more chiropractors helping people become healthy and drug free then the medical profession. On top of that there are corrupt people in any and every profession.
Like I said earlier, many of the people who constantly ask for evidence will never have enough.
Joe,
You seem to enjoy setting up straw-man arguments. No one said DCs didn’t need to do research. It’s pretty evident you haven’t bothered to read any of the comments directed towards you.
If you intend to post here again, please begin your next commentary with documentation to support your claim that “treatments that don’t have good RCT data as evidence is more like 80%, not 15%”.
Otherwise, I will block your posts for being an insincere nuisance.
What proportion of healthcare is evidence based? Resource Guide. For general medicine and GPs, the figure is around 80%. See also the British Medical Journal.
The oft-quoted 15% is low because it included all sorts of ineffective AltMed treatments as well as conventional treatments. This inevitably pulled the percentage way down.
However, this is a complete red herring. Your post at the top of this page asserts that chiropractic has “been shown to be effective for relieving symptoms of chronic middle ear infections”. That’s what I questioned in my first comment and what I am still questioning – what the evidence for efficacy actually is, not what evidence there is or isn’t for conventional medicines. Apart from personal experience, what else is there?
To answer Graeme Gibson’s red herring: “I’ve always found that the people that there will never be enough evidence for some people. EVER.”, just a couple of methodologically sound, randomised, blinded, controlled trials will do for me. Are there any?
The ACA alone has 9,148 members – isn’t chiropractic a billion dollar industry in the US alone?
RESPONSE from Frank:
Joe,
Thanks for supplying the comparison chart. The numbers were all over the place (typical) but none of them equaled your claim of 80%.
Your claim that “The oft-quoted 15% is low because it included all sorts of ineffective Alt-Med treatments” is TOTAL BULL, mainly because that article was published in the British Medical Journal in 1991. How much alt-med literature was available AT THAT TIME (?) which if they had been rated, could be used to water down a review of medical treatments? HOGWASH, inaccurate, spurious, misleading, and dare I say it, an outright obfuscation of FACT, meant to deflect the conversation, to support your evidently anti-Alt-Med posture..
I’m less clear why you mention the BMJ pie chart, as it is rather damning of the efficacy of the medical approach. In fact, the author states:
That’s a bit of an oxymoron, isn’t it? They start off by reviewing “treatments supported by good evidence”, but conclude that “the remaining 47% the effect of the treatment was “unknown”…
answer me this…if the effect was unknown, how did it ever get included on a list of treatments “supported by good evidence”? Does that make ANY sense at all?
To me, good evidence is that evidence that would actually support the use of a procedure. I assure you, if 47% of the effects of chiropractic care were unknown, there would be NO chiropractic profession left to argue about.
To get back to the initial discussion about the benefits of chiropractic care for children who happen to have otitis media, my personal experience with patients supercedes my worrys about the “quality” or quantity of studies available to support what I do. I am the doctor, and I get to decide.
The issues surrounding the Simon Singh case has nothing to do with how much research is available. I agree with Simon that we don’t have enough, and most of what we do have is viewed as weak in the hierarchy of EBM. No argument there.
The problem is that Singh slurred my profession…and as a “professional” science writer, he clearly understood the power of the words he wrote… by calling what we do BOGUS. I support the BCA 100% for their suit against him. Do they still burn at the stake in England?
Joe
You said 1 or 2 randomized trials would satisfy you. Are you familiar with the 2007 Blood Pressure study done here in Chicago (at Rush University Hypertension Center)? [1] If not, you can access the FULL-TEXT study now.
This double blind, placebo-controlled study demonstrated that upper cervical adjusting lowered blood pressure as effectively as a two-drug combination therapy, AND that it was sustained, not just a short-term reduction, as with taking a drug.
I think you will find this study to be quite fascinating.
REFERENCE:
1. Atlas Vertebra Realignment and Achievement of Arterial Pressure Goal in Hypertensive Patients: A Pilot Study
Journal of Human Hypertension 2007 (May); 21 (5): 347–352
Frank
A pilot study?? Even then, there are some problems with it (eg the practitioner treating the placebo group was not blinded), but it does seem to show a change for whatever reason. However, you also claim it “demonstrated that upper cervical adjusting lowered blood pressure as effectively as a two-drug combination therapy”, but the control wasn’t normal care – it was sham manipulation so it can’t claim that chiro is as effective as something it wasn’t compared against!
On its own, it is insufficient to substantiate a claim that chiro is effective for lowering blood pressure, but it may be adequate to justify a larger study.
However, I can find no full study following on from this. Do you know if one has been (or is being) carried out? It has been two years…
Besides, even if there was a repeatable result from a robust trial for chiro for lowering blood pressure in adults with a ‘mean age 52.77 +/-9.6 years’, what’s that got to do with ear infections in infants?
Joe,
Thanks for your comment that “it does seem to show a change for whatever reason“. I have been in contact with a medical researcher named Jim Deuchars, PhD of the University of Leeds. He and his group had been studying the Intermedius Nucleus of the Medulla when this “pilot study” was published, and in his article he stated:
Additional evidence for the involvement of the suboccipital muscle group in the cervico-sympathetic reflex comes from changes in blood pressure associated with chiropractic manipulations of the C1 vertebrae (McKnight and DeBoer, 1988; Knutson, 2001), which would result in altering the length of fibers in the suboccipital muscle group. The projection from the InM to the NTS identified in this study therefore places it in an ideal position to mediate cardiorespiratory changes to neck muscle afferent stimulation, because the NTS is a major integratory area for autonomic control circuits (Potts, 2002). Future studies are therefore required to examine the role of these neck afferents in cardiorespiratory regulation. [1]
So little by little research will uncover HOW spinal adjusting (or manipulation) gets the results it gets. However, I need to ask you:
In a study involving the physical handling and adjusting of patients (as opposed to handing out tablets of medicine) how would YOU propose blinding either the patient OR the provider? It’s just not possible. Blinded trials work well with tablets, because you can make the placebo look like the drug you want to test.
So far, most of the “sham” asjusting trials were a disaster because the sham group AND the treatment group had similar results, concluding that the treatment was no more effective than a sham. UGH!
However, when you read the full-text papers, the reality is quite different, because both groups improved over baselines. So, this means that the shams provided some “non-specific effects” that led to improvement. Please refer to the Problem with Placebos/Shams Page for more on that topic.
The next issue is what is “evidence”? Sackets concept of Evidence-based treatment has three components;
[1] the current scientific literature, which includes more than randomized controlled clinical trials,
[2] the clinical expertise of the health provider and the
[3] desires and needs of the patient. Case Reports are low on the hierarchy of evidence, but they ARE on the list.
More trials are being funded all the time. If we added up the funding for all those trials, and compared it to the full NIH budget, you’d see that chiropractic is still receiving less than one tenth of 1 percent of the budget. That’s homeopathic doses of money…hehehe…and in fact, the whole budget for all CAM studies is tiny, but growing.
REFERENCE:
1. The Neurochemically Diverse Intermedius Nucleus of the Medulla as a Source of Excitatory and Inhibitory Synaptic Input to the Nucleus Tractus Solitarii
J Neurosci 2007 (Aug 1); 27 (31): 8324-8333 ~ FULL TEXT
Frank,
Great commentary and information.
One of the biggest differences between a chiropractor and medical doctor is the understanding of where health comes from.
Not all medical doctors agree that health comes from within, and the body/nature/innate ability does the work. Not medicine, not adjustments, not even surgery.
Interference may need to be removed from the body, physically, chemically, emotionally. However, the body is still in charge.
How do you prove this scientifically? You can’t. It just happens, and no double blind study will show different.
This fundamental difference in thinking about the way the body functions and heals is why there is so much anecdotal evidence, and so studies. That and money for the research.
Much of medicine is simply symptom based. If the symptoms are gone, the person is healthy. Their current treatment of antibiotics and/or surgery has been shown to be a temporary fix, or no fix at all(The average number of rounds of antibiotics a child with ear infections is on is 8. This shows that antibiotics are not a FIX for ear infections, and a double blind study would show this.)
I would love to be in a double blind study if anyone wants to arrange it, pay the costs, and give me the guidelines. I will take all the kids in the study free of charge.
RESPONSE from Frank:
Graeme
To get funding, you need to write proposals etc,
I initially recommended getting involved in Practice-based research, but I just heard back from Cheryl Hawk, D.C. that Cleveland Chiropractic College had to discontinue their program because of the budget crunch.
Frank
“So little by little research will uncover HOW spinal adjusting (or manipulation) gets the results it gets.”
That’s certainly not how science works: asserting the answer you want before doing the research!
I would have thought that chiropractors would be the experts on the best way to perform sham chiropractic, so I’m not sure why you’re asking me. However, what have chiropractors ever done to research this?
What David Sackett doesn’t say is that evidence from the ‘lower’ levels trumps that obtained from the higher levels. The hierarchy is clear: case studies are no substitute for good quality trials. But that always seems to be what’s put forward when chiropractors are asked for the evidence they hold for what they already do.
How much do NCCAM spend on chiropractic research? What’s being done by chiropractors, the chiropractic trade bodies and colleges to persuade them to throw some of the public’s money in the direction of chiropractic researchers? What are all the PhD students at the colleges researching?
It was probably a bit misleading for me to quote the membership of the ACA earlier. They have less than 10,000 members, but there are some 70,000 chiropractors in the US, with that number expected by some to rise to 145,000 by 2015. That already makes it an industry worth a tens of billions of dollars. Just think what even 1% ($70 million) could achieve if spent on properly designed RCTs!
You still haven’t answered the question central to your original post: what’s the evidence that allows you to claim that chiropractic has “been shown to be effective for relieving symptoms of chronic middle ear infections”?
RESPONSE from Frank:
I understand your point about research, etc, but I am a clinician, not a researcher. I am a fan, however, and that’s why I collect those materials on our website. So, please understand I think and speak from my experience with patients. My expectation is that research will eventually explain the results I see in my office. And YES, that is science.
Doctors do what they are taught until (or unless) science (research) demonstrates that what they are doing is not helpful, or is LESS helpful than some other method. Currently, no other treatment for otitis media shows better results than chiropractic. Period!
The membership the ACA quotes also includes 3 to 5 thousand student members. The last time I did a serious poll of all the national chiropractic associations (in 1999) the total Doctor membership of the ACA was less than 4000, or only about 8% of us.
Considering that the ACA membership fee (600 per year) also includes a free subscription to JMPT (normally 120 a year…not sure how big a discount ACA gets) that leaves them with 4,000 x 500 or less than a half a million per year to do ALL of their legislative work, and to support research.
FCER, our primary non-school fund for research has (at best) 2000 members, paying dues, so most of the money they have to pay for any research came from supportive businesses…a drip and a drab here or there.
So…you prattle on about how much research we could do with your imaginary 70 million (and of course, I have to agree)…but the way I see it, it’s amazing how much quality research we HAVE ALREADY DONE, considering the paltry funds that our profession has access to, mostly funded by our own schools.
And finally, your suggestion that WE fund all our research is outrageous. NO OTHER PROFESSION does, and YOU CONTINUE TO IGNORE THE FACT that we already paid for what research there is. That has to stop.
There’s plenty of evidence that chiropractic is helpful. Insurance companies (and Medicare) pay for it. So, it’s not unreasonable to expect that a larger portion of the NIH budget will be devoted to chiropractic research in the future. Stay tuned.
Here’s some examples of amazing studies our profession funded:
For example:
Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Clinical Trial
J Manipulative Physiol Ther 1995 (Mar); 18 (3): 148–154
Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-year Update
J Manipulative Physiol Ther 2007 (May); 30 (4): 263–269
Predictors For Immediate and Global Responses to Chiropractic Manipulation of the Cervical Spine
J Manipulative Physiol Ther 2008 (Mar); 31 (3): 172–183
Joe,
The evidence is certainly seen in my office with the many children we have taken care of who have had diagnosed otitis media.
I’m sure that’s not enough evidence for you. I am unsure of your qualifications, but you are more then welcome to design the RCT and involve me.
On that other comment…10’s of billions??? Man oh man you couldnt be more wrong. I think you have our profession mixed up with the sales of viagra! haha.
I saw 10 patients with ear infections, those 10 all got well, for me chiropractic works.
That seems to be the fundamental difference: you are willing to accept what you see. Unfortunately (and please don’t take this personally – we’re all subject to it), the observer-expectancy effect is well documented and a very considerable and a real problem.
This effect comes up all over the place, but it is particularly important when we’re talking about health. The way to ensure that any effects noticed really are there and are due to the treatment being given is to make sure there is no bias – that the tests are truly independent. That’s where the blinding and randomisation come in. Hence the need for carefully designed trials.
Thanks for pointing out my arithmetical error! It’s only $7 billion income (I think that could be a very conservative estimate), but the 1% figure is correct at $70 million. Do you know what the average chiropractic income is?
It’s an interesting point about the ‘size’ of the Viagra market! I have no idea what it is.
Joe,
Well I don’t think you have any idea what size the chiropractic market is. It should be in the 10’s of billions, as this would mean many more people would be getting adjusted, and healing without relying on drugs and surgery.
If you do not know what #’s the drug market is pulling in, you shouldn’t be complaining about the measly amount chiropractor’s are earning. Like I mentioned in a different post, 2 cholesterol lowering drugs that were shown to have no significant benefit in 2006, and the results not given until 2008, pulled in 1 billion dollars for the 3rd quarter of 2008. Why no issues with this?
Yes I do believe what I see. When a child comes in with multiple diagnosed ear infections from birth to the time I see them, and on their last round of antibiotics before having tubes inserted into their ears. I get the worst case scenario, and am the last resort many times.
With a 95% resolution rate in my 8 years of practice, this is more then a coincidence. Argue all you want, it isn’t a fluke. Otherwise these mothers and fathers wouldn’t be telling all of their friends with the same problems.
Joe, you still haven’t mentioned what your profession is, or revealed your interest in chiropractic research.
Joe,
I would agree that unity and charity towards research in the profession would be fantastic. It would be amazing. I actually do belong, to the ICA, and do donate money towards research. My principles are not aligned with much of what the ACA does. However, for the good of the entire profession it would be a fantastic idea if Chiropractors could come together as the AMA did along time ago.
You seem to be bringing up issues that I do not entirely relate to research, so I would like to bring up some comparisons.
Where do M.D.’s, PhD’s, and Universities receive their money for research from? Is it from the actual practitioners?
The majority are received from Big Pharma when they want to prove something, or from the government when they want to research something. Not from individual MD’s and PhD’s.
Yes 1% of that median salary towards research would be great.
The lack of current research does not disprove the effects chiropractic adjustments are having on children with otitis media.
By the way, you didn’t pay any taxes and expenses on that 100k. Again, for the sake of fairness, please enlighten us on the salaries of MD’s and their specialties.
Joe,
I sincerely would also like to ask again. What do you do? What is your interest in what chiropractor’s are doing?
Have you ever seen one or spoken to one?
If you’re ever in Seattle, please come and visit.
I removed Joe’s last post and blocked him from further posting because his commentary is WAY too antagonistic.
This Blog posting (on middle ear infections in children) directed our readers to look at a U-Tube video, and to our page on Otitis Media. It does NOT claim that we have tons of research. This article is solely an attempt to explain the possible mechanism of why children seems to respond well to upper cervical adjusting, when they have recurrent ear infection.
When Joe asked “It has to be asked why there are no RCTs that demonstrate the apparent efficacy of chiro for ear infections” I explained that the reason we have a dearth of studies is because almost all the research we DO have was paid for from our own pockets. That’s unparalleled in the healing professions.
Why, you might ask, did we pay for our own research? Well, mostly because the medical establishment spent years (and millions) to attempt to destroy our profession. They threatened their own ranks with loss of hospital privileges if any MD taught in our schools, participated in research with us, or published our studies in their journals. UNBELIEVABLE! And, they were finally found guilty of ant-trust activities against us…twice… also an unparalleled event. It doesn’t matter if you like that Joe, that’s just the way it is.
Then, on 12-10 he asked “how many chiropractors are there and how much money are they making from the public?” Guess what, Joe? That’s disrespectful, and it’s none of your business.
On 12-12 he said “We’re talking about taking money from people who may have serious medical conditions.”
The topic was middle ear infections, and you already stated on 11-13 that “Since ear infections will generally clear up all by themselves (without care)“, so your question was disingenuous, as well as misleading. It seems intended to start a fight, NOT to gather information or to understand.
Finally, and most irritatingly, on 12-21 you suggested “That already makes [chiropractic] an industry worth a tens of billions of dollars. Just think what even 1% ($70 million) could achieve if spent on properly designed RCTs!”
Somehow you have ignored the fact that we ALREADY paid for almost all of our own research. US. Not you, professional (???) Blog Critic.
Who are you to suggest we donate 1% of our personal incomes to pay for more? You have stepped beyond reasonable discourse into the ridiculous. This is a doctor’s forum. Our members have politely responded to your questions (most of which you have ignored), and now it appears we’re being baited by you. Who needs that?
Joe, I welcome you to introduce yourself, tell us what you do for a living, and explain why you are so (dis-)interested in chiropractic.
If you are here to cause mischief, be gone!
If you want to learn, ask.
If we don’t see eye-to-eye, that’s just the way it goes.