From what you say, I’m assuming that ‘sham’ Chiropracters are every bit as good as the ‘real’ ones, but presumably cheaper.

Can you recommend any?

I just COULDN’T resist writing a comment on the “Minister of Truth” website. Here it is:

Ministry of Truth? How divinely Orwellian!

Your criticism of Klougart et al. makes me suspect that you have never received a chiropractic adjustment. If you had, then you should know that it would be impossible to fulfill your demand for “blinding” . In fact, designing a truly inert “sham” adjustment has so far eluded many sophisticated researchers in manual medicine (DOs and DCs both). You can read more about that topic at the “Problem with Placebos/Shams” page at:

http://www.chiro.org/research/ABSTRACTS/Placebos.shtml

You then blithely state that “colic being a condition that typically improves over time”. Really? And what time frame is that?

Any procedure for any illness has to face up to what is referred to as the “natural history of the disease”. If you could “prove” that colic always resolved in 2 weeks or less, then you’d have a leg to stand on, since the research results were “results occurred within 2 wk and after an average of three treatments.” However, if colic routinely last longer than 2 weeks (place your bets!) then it sounds like these researchers are onto something.

You can read the abstracts for many colic studies at:

http://www.chiro.org/research/ABSTRACTS/Colic.shtml

Then you whine about the Mercer and Nook study, right after stating that the problem with Klougart was that it lacked a control group. Well, what would you call the 15 (who were) were ‘treated’ with non-functional, detuned, ultrasound? Gee, partner, you can’t have it both ways.

You want to know the REAL problem with Chiropractic research? Last year, the National Institute of Health (NIH), who is the primary funder of “medical” research in the USA had a budget well in excess of 30 BILLION dollars. Would you like to guess how many funds were devoted to ALL forms of alternative medicine (not just chiropractic)??? It was under 20 MILLION dollars. That is less than a rounding error…fractions of one tenth of one percent.

The REAL problem is that the American Medical Association spent more than 30 years trying to destroy my profession. Then they threatened any medical doctor with loss of license if they taught or researched with chiropractors.

So, guess who paid for all our research? We did (meaning our own schools and professional associations).

Name ONE medical research department ANYWHERE that funds their own research? Good luck! They are ALL on the dole from Federal funding, which was explicitly or implicitly denied to my profession. I believe the first Federal dollars to fund any chiropractic research didn’t arrive until (around) 1998. And to date, I doubt it amounts to more than 20-30 million. So…EXCUSE US for not having the pristine research you seem to hunger for.

The way to truth, oh Minister, is found by talking to people who receive chiropractic care. Speak to the parents of those screaming children. Guess what you’ll hear? SATISFACTION. Don’t believe me? Well, check out the Patient Satisfaction Page

http://www.chiro.org/LINKS/Patient_Satisfaction.shtml

Over time, with growing infrastructure, mostly paid for out of our own pockets, we will develop the research you crave. In the meantime, there is NOTHING wrong with relying on the “expertise of practitioners”. After all, we are the ones who attended the 10 (or so) years of college to learn our art, craft and science.

I feel your pain. The primary problem with all this EBC criticism is asking for “blinding, randomisation and a control group.”

Numerous chiropractic studies (using sham adjusting) claimed that manipulation failed to provide benefit, when in fact, if you read the whole study, it was found that BOTH the manipulation group AND the sham group improved, compared to the null treatment group. This is NOT a failure of SMT to provide benefit…it was a failure to design a sham adjustment that didn’t also provide improvements. The The Problem with Manual Placebos page is devoted to this issue in more depth. It’s not just our problem…DOs and PTs face the same seemingly insurmountable hurdle.

Let me pose a simple question: can you design a sham form of massage? When you look at it that way, the answer is obvious.

Anthony Rosner, PhD has crafted a superb article, titled Fables or Foibles: Inherent Problems With RCTs that addresses the weakness of using RCTs for “manual medicine” approaches. His conclusion:

The 7 case studies reviewed in this report combined with an emerging concept in the medical literature both suggest that reviews of clinical research should accommodate our increased recognition of the values of cohort studies and case series. The alternative would have been to assume categorically that observational studies rather than RCTs provide inferior guidance to clinical decision-making. From this discussion, it is apparent that a well-crafted cohort study or case series may be of greater informative value than a flawed or corrupted RCT. To assume that the entire range of clinical treatment for any modality has been successfully captured by the precision of analytical methods in the scientific literature, indicates Horwitz,32 would be tantamount to claiming that a medical librarian who has access to systematic reviews, meta-analyses, Medline, and practice guidelines provides the same quality of health care as an experienced physician.