Editorial

Is “Expanded Practice” our Pandora’s Box?

By Frank M. Painter|September 13, 2011|Editorial, Expanded Practice|

Is “Expanded Practice” our Pandora’s Box?

I just read a Press Release from the Foundation for Vertebral Subluxation (FVS) this morning, titled “Chiropractors Lash Out in Massive Campaign Against Accrediting Agency“.

Previous press releases from this group have denounced (perhaps rightly) any movement to include prescribing rights for DCs, and this Blog has published extensively about both sides of that debate in the past. [1–15]

Personally, I think that seeking prescription rights is a bad idea because of the political and legal turmoil it will invite from Organized Medicine. The authors of the Foundation typically paint the “Pro Drug” movement as an attack against the idea of the Vertebral Subluxation and of the profession’s historical foundation, as one that does not use drugs and surgery to accomplish our goals.

It’s now time for the Profession to determine if this is “Chicken Little” paranoia,
or if the FVS has a valid concern that MUST be addressed.

According to their Press release, there is a “massive and historic outpouring” of dissatisfaction by “at least 6000 chiropractors” via “Facebook, Twitter and e-mail“. The author goes on to state that “At issue is the systematic remaking of the profession by these groups into a branch of medicine.” OK, that got my attention.

NOTE: It may be true that this page has 6000 “members”, but MANY of them (like myself) were added to that list without our knowledge or permission. So their claim of 6000 “members” is spurious. Further, even if it WAS true, 6,000 DCs represents less than 10% of our Profession. Hardly a ground swell movement. (more…)

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And, Speaking of Professor Edzard Ernst: If The Shoe Fits…

By Frank M. Painter|August 24, 2011|Editorial|

Double Standards Exist in Judging Traditional and Alternative Medicine

The Chiro.Org Blog

SOURCE:
British Medical Journal 1998 (Jun 6); 313: 1694

By Hilary Bower

This posting is dedicated to all those evidence-based nay-sayers out there, who love to criticize without contributing anything except negativity.

Dr. Chalmers is the head of the Cochrane group in the UK. He speaks for the REAL evidence people.

Dr Iain Chalmers, the director of the UK Cochrane Centre and a vociferous proponent of systematic reviews, told delegates:

“Critics of complementary medicine often seem to operate a double standard, being far more assiduous in their attempts to outlaw unevaluated complementary medical practices than unevaluated orthodox practices.”

He also said:

“These double standards might be acceptable if orthodox medicine was based solely on practices which had been shown to do more good than harm, and if the mechanisms through which their beneficial elements had their effects were understood, but neither of these conditions applies.”

(more…)

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The Inherent Problems With Randomized Controlled Trials

By Frank M. Painter|August 15, 2011|Editorial, Research|

The Inherent Problems With Randomized Controlled Trials (RCTs)

The Chiro.Org Blog

SOURCE: J Manip Physiol Ther 2003 (Sep); 26 (7): 460–467

Anthony Rosner, PhD

Foundation for Chiropractic Research and Education,
1330 Beacon Street, Suite 315,
Brookline, MA 02446, USA.

For 50 years, the accepted standard by which the usefulness of a therapeutic treatment is judged has been the randomized controlled trial (RCT), building from Hippocrates’ premise 2000 years ago that experience combined with reason was the therapy of choice for patients; that is, any treatment plan should both seem reasonable in theory and then be tested experimentally. Assuming that threats to both internal and external validity could be ruled out, the RCT became what is commonly regarded as the highest quality of clinical outcome study that could be mounted to allow inferences about cause and effect relationships to be drawn. The thinking was that the more rigorous and fastidious the design, the more credibility could be attached to the conclusions drawn from the outcomes of the study and the more likely the intervention was thought to have brought about those outcomes. [1] One of the strongest proponents of the RCT through the 1950s and 1960s was the British epidemiologist Archie Cochrane, who held that this type of experimental approach was essential for upgrading the quality of medical evidence. [2] In common hierarchical schemes of clinical experimental design, the RCT has been ranked the highest in rigor, as shown in Table 1.3 Even greater rigor has been presumed to occur with the statistical combination and weighting of the results of multiple RCTs in a meta-analysis to generate a more conclusive estimate of effect size. [4-5]

Table 1. Hierarchy of Experimental Designs [3]

Control group outcomes study (including RCTs).
Single-subject experiment, replicated single-subject experiments.
Single-group outcome study.
Systematic case study.
Anecdotal case report.

Designs are presented in descending order of rigor.

(more…)

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Chiropractic Research Testimony at the National Institute of Medicine

By Frank M. Painter|August 8, 2011|Editorial, Research|

Director of Chiropractic Research Testifies at the National Institute of Medicine

The Chiro.Org Blog

Anthony L. Rosner, Ph.D.

Foundation for Chiropractic Education and Research

Anthony Rosner, Ph.D., Director of Research and Education for the Foundation for Chiropractic Education and Research, presented testimony on behalf of chiropractic research and practice standards at hearings conducted at the Institute of Medicine (IOM) headquarters in Washington, D.C., on February 27, 2003. The occasion marked the first of six meetings of a study committee planned by the IOM over the next 18 months to explore the scientific and policy implications of the use of complementary and alternative medicine (CAM) therapies by the American public.

The objectives of the study committee are as follows:

To describe the use of CAM therapies by the American public, including the populations that use them and what is known about how they are provided;

To identify major scientific and policy issues related to CAM research (including gender effects), regulation, interactions with conventional medicine, and training and certification; and

To develop conceptual frameworks for guiding decision-making on these issues and questions.

The Institute of Medicine is a private, non-governmental organization that initiates studies in areas of medical care out of appropriations made available to federal agencies. It is a branch of the National Academy of Sciences, which was created by the federal government to be an advisor on scientific and technological matters.

The following is Dr. Rosner’s presentation to the Institute of Medicine.

The Use of CAM by the American Public

INTRODUCTION

My dear colleagues:

I want to thank the Institute of Medicine (IOM) for two reasons; first, for inviting my testimony this afternoon, but especially for carrying what I believe is the unfulfilled work of both the National Center for Complementary and Alternative Medicine and the White House Commission on Complementary and Alternative Medicine an essential step forward by calling us to the table today.

I also want to offer my strongest assent and congratulations to the Institute for its most pertinent and insightful assessment of American healthcare — first, in its forthright reporting of medical errors in 1999; [1] second, in providing one of the most equitable definitions among the many offered for “primary care; [1] [2] ” and finally, for having published two years ago the most candid and uncompromising assessments of U.S. healthcare, Crossing the Quality Chasm: A New Health System for the 21st Century. [3]

This last publication courageously concluded that “the American healthcare system is in need of a fundamental change,” especially because “what is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns. . . .” [3] (more…)

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The Obstacles and Barriers to CAM or Alt-Med Research

By Frank M. Painter|August 3, 2011|Editorial, Research|

The Obstacles and Barriers to CAM or Alt-Med Research

The Chiro.Org Blog

SOURCE: Testimony to the White House Commission On Complementary and Alternative Medicine Policy

By Anthony L. Rosner, Ph.D.

FCER Director of Research and Education

Introduction:

Until 25 years ago, chiropractic research was vastly underdeveloped and appeared to some as an oxymoron. In 1975, a conference at the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institutes of Health (NIH) concluded that “There are little scientific data of significance to evaluate this (chiropractic’s) clinical approach to health and to the treatment of disease.” [1] From that time onward, both clinical and basic research have advanced to the point at which:

(i) over 40 randomized clinical trials comparing spinal manipulation with other treatments in the management of back pain have been published in the scientific literature, [2, 3](ii) meta-analysis and systematic reviews attesting to the support of spinal manipulation in the management of back pain [4, 5] have also appeared, and(iii) multidisciplinary panels representing the governments of the United States, [6] Canada, [7] Great Britain, [8] Sweden, [9] Denmark, [10] Australia, [11] and New Zealand [12] have expressed similar recognition of the robust evidence base in support of spinal manipulation for managing low back conditions.Barriers:

The efforts to launch and develop a National Center for Complementary and Alternative Medicine (NCCAM) within the framework of the NIH are indeed admirable, taking the Center from a humble $2 million annual budget in 1991 to one that approaches $70 million today. This has taken place despite the comments of highly visible and influential individuals within the medical community to discredit alternative medicine in virtually any shape or form, a topic that I shall return to momentarily.

The following are what I believe to be the most significant barriers to research efforts in alternative medicine, the barriers having either remained in place or only recently having been removed.

1. Collaborative Arrangements: (more…)

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Plastic Surgery For Headaches???

By Frank M. Painter|June 20, 2011|Editorial, Headache|

Plastic Surgery For Headaches???

The Chiro.Org Blog

SOURCE: Plastic & Reconstructive Surgery 2011 (Feb); 127 (2): 603-8

A Chiro.Org Editorial

Now I’ve heard everything (well. . . maybe). A recent full text article in the journal Plastic and Reconstructive Surgery [1] fully describes how plastic surgeons attempt to mimic the common outcome of chiropractic upper cervical adjusting by:

removal of a small segment of the semispinalis capitis muscle and shielding of the nerve with a subcutaneous flap to fully decompress the greater occipital nerve.
(from Page 604) [2]

No mention is made in their celebratory article about the massive expense of this procedure, or the success of chiropractic care (or “spinal manipulation”) for headaches, but then again, these are surgeons, forging ahead, looking for an approach they can call their own. Good for them.

However, Chiropractors developed a non-surgical and cost-effective way to decompress the greater occipital nerve many decades ago, by adjusting the occiput, and by using NIMMO technique to naturally eliminate trigger points of the suboccipital muscles (the myofascial component).

Travell’s 1983 landmark magnum opus on trigger points titled: “Myofascial Pain and Dysfunction: The Trigger Point Manual” clearly identifies the various suboccipital muscles as being primary triggers for several varieties of headache. This Blog, and our Headache and Chiropractic Page have published regularly on the success of chiropractic care for headaches of all sorts. [2-7] (more…)

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