Happy Fourth of July to you all from Chiro.org

Drop by and enjoy the fireworks!

As long as we’re on the topic of Evidence-based Practice, you’ll enjoy Anthony Rosner PhD’s article “The Shifting Sands of Evidence-based Medicine”.

Robert D. Mootz, DC, who is the Medical Director for the State of Washington Department of Labor and Industries also penned an interesting review in JMPT titled “When Evidence and Practice Collide” (FULL TEXT) that sheds a lot of light on EBM issues.

Add to this the complication that, by JAMAs own standards of evaluation, “between 18 and 68 percent of the 264 abstracts evaluated from major medical journals were inaccurate”. Why is this a problem? Meta-analysis starts with a review of potential materials…and what’s initially reviewed is the ABSTRACT, not the full-text article.

Lastly, it has been stated, by the editor of BMJ (the prestigious British Medical Journal), that “only about 15% of medical interventions are supported by, solid scientific evidence”. This is no excuse for us to be negligent, but excuse me if I ask them why they are expecting US to maintain a higher standard then they do?

There’s a lot more info like this in the Section

You can find it all with our Section

After enjoying John’s posting on the Canadian BCA/Singh case, I feel it’s time to pour some gas on the conversation, to heat things up a bit.

First, you can review the articles under consideration at the Chiropractic and Infantile Colic page.

Then, read Anthony Rosner, PhD’s delightful article “Fables or Foibles: Inherent Problems With RCTs“, as he points up the issues of testing “manual medicine” by RTC.

Finally, you can review previous “failures” in developing a truly inert sham adjustment.

I don’t envy researchers who must overcome these obstacles, but in the mean time, there’s no shame in relying on Case Studies and retrospective treatment reviews to help ground us in reality while we design a treatment plan.

Previously I wrote about the British Chiropractic Association suing science writer Simon Singh for libel. This has been widely criticized as a tactical mistake due both to the expense and to the negative publicity which has thus far ensued. The BCA has recently produced a list of evidence justifying the chiropractic treatment of children with asthma and colic which evidence-based blogs have proceeded to, for want of a better term, eviscerate. One of the criticisms was for the BCA not including a study which showed manipulation to be no better than placebo for infantile colic.

Continue reading …

Patient Satisfaction Surveys going back to the late 1980s show that patients with neck or low back pain, headaches, and a variety of other physical complaints rate their satisfaction with chiropractic care much higher than they do conventional care provided by physical therapists or medical doctors.

Now let’s discuss the amazing results chiropractic can provide for pain relief. A 2005 study, from the prestigious medical journal Archives of Physical Medicine and Rehabilitation, titled Chronic Pain in Persons With Neuromuscular Disease interviewed patients on the pain relief they derived from a variety of procedures and medicines.

Pain relief was rated on a 1 to 10 scale (where 1 = none, and 10 = the highest relief). The highest rated score was for chiropractic manipulation (7.33), rating higher than Nerve Blocks (6.75) and Opioid Analgesics (6.37). There you have it…chiropractic is better than drugs, not to mention the fact that drugs wear off, while chiropractic correction has been shown to sustain for prolonged periods.

You will find many more articles like this at the Patient Satisfaction With Chiropractic Page.

Source Medscape
Steven I. Kern, Esq.

An estimated 85,000 medical lawsuits are filed annually, which include those against hospitals and individual physicians. One of the highly-touted benefits of electronic medical records (EMRs) is the potential to help prevent malpractice incidents and medical errors. By providing better documentation, automatically checking for medication errors and drug interactions, providing failsafe systems to track test results and follow-up with patients, EMRs can dramatically reduce the risk of malpractice.

While the benefits of EMRs are far greater than the cons, no road is without stumbling blocks. A physician who is not careful when using the EMR could increase his malpractice liability.

Some of the possible malpractice risks are shown below.

Continue reading …

Radiculopathy is characterized by motor and/or sensory changes in the neck and arms, or the legs and feet, which result from extrinsic pressure on the nerve root(s). Chiropractic is very effective in reducing that pressure on the nerve roots (oftern caused by edema), and as the nerve recovers, those down-stream symptoms abate.

Come explore the Radiculopathy Page and learn more about radiculopathy, and chiropractic approach to management.

Modafinil is a popular drug used by people who want or need to stay alert. It has become a popular stimulant, used by soldiers to stay awake and by citizens looking for a safe brain boost, including one in 10 researchers. The FDA issued their “Approved” stamp for it to be used for treating narcolepsy and sleep disorders in 1998. At that time, scientists claimed that it did not change levels of dopamine in those who took the drug. Increases in dopamine levels are considered a chemical signature of possible addictiveness to a drug. Since its FDA approval, modafinil is now being used “off-label” to treat depression, Parkinson’s disease and fatigue.

However, the March 2009 issue of JAMA published this study;

Volkow N, et. al., Effects of Modafinil on Dopamine and Dopamine Transporters in the Male Human Brain., JAMA, Vol. 301, No. 11, March 18, 2009.

You can read more on this report at the Wired Science Blog.

Do you make nutritional recommendations as part of your Care Plan? Do you recommend supplements? Do you carry supplements in your office?

Many chiropractic schools only provide a 3-credit class in nutrition, so students have to study on their own to develop confidence in offering recommendations.

Our Nutrition Section is an information rich and non-solicitous resource for you to learn more about supplementation and diet modification. The first section (Supplements) discusses specific vitamins and herbals.

I hope you will find this a useful resource!

Do you use acupuncture in your practice? If so, you may want to review our Acupuncture Section.

This page compiles recent studies on acupuncture, as well the principal World Health Organization guidelines and reviews. It also contains a variety of acupuncture charts for your use.

A new study just revealed that stimulant medications, specifically methylphenidate, are associated with a 6- to 7-times increased risk for sudden death in children and adolescents. UGH!

What does the FDA say about that? “Given the limitation of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat attention-deficit/hyperactivity.”

The ADD/ADHD Page is devoted to the holistic approach…chiropractic care, dietary modification (no more food colorings and preservatives!), and no more dangerous drugs!

This is just one of many pages in the Pediatrics Section .

Vaccination is a controversial topic with chiropractors because of our non-drug and non-surgery approach to health. The Vaccination Page attempts to present both sides of the vaccination issue.

The Women’s Health Page contains a wealth of articles addressing fertility and menopausal issues.

It also links to the ADD/ADHD Page. This page discusses conservative management protocols, including chiropractic care and nutritional management.

There’s a lot more info like this in the Section

In a Guardian article in April 2008, Simon Singh, who has penned the popular science books “Fermat’s Last Theorem”, “The Code Book” and “Big Bang”, wrote about the likely risks of chiropractic treatment and whether or not there was any evidence that it was effective for various childhood conditions, including asthma and colic. The British Chiropractic Association (BCA) took offense to this, claimed that Singh had defamed their reputation and has sued him for libel.

Notwithstanding that in libel cases in Britain, it is the defendant who carries the burden of proof, and that this would be very expensive, Singh decided last year to fight on as experts said “we had a valid defence and stood a good chance of winning the case.”

However, this from the Index on Censorship website – On May 7th, 2009 the English High Court ruled that Singh must show that the British Chiropractic Association (BCA) was deliberately dishonest in promoting chiropractic as a treatment for various children’s ailments.

Mr Justice Eady ruled, with notes apparently written prior to today’s preliminary hearing, that an article by Singh, published in the Guardian should be classified as a ’statement’ and added that by use of the word ‘bogus’ Singh had inferred he believed the BCA had intent to convey dishonest claims to the British public.

In light of this ruling the matter may not go to trial. From Singh’s standing he does not believe the BCA had intent to deceive and therefore cannot prove this.

Costs of £23,000, relating to the preliminary hearing, have been awarded to the BCA.

Here is some discussion including an intelligent posting by the vice president of the BCA.

Continue reading …

I’m not sure how many chiropractic schools teach extremity adjusting (ankles, wrists, elbows, shoulders), but if you do extremity work, then you will love the The Shoulder Girdle Page.

The page starts with scholarly papers by Richard Schafer, D.C. on managing shoulder and joint trauma. It also contains several other FULL-TEXT papers on shoulder management. I hope you will find this of interest!

There’s a lot more info like this in the Section