Response: Is chiropractic for real or just quackery?

Drs. Novella and Gorski, et al. are highly respected physicians who back up their opinions with evidence. Evidence=facts, and when facts are added to opinions, you get a better opinion, one that actually means something. IOW, the “opinions” expressed at SBM aren’t argued ex culo as so many others are, including those from other MDs.

Irrelevant. Dr. Novella does not teach Integrative Medicine, acupuncture is not chiropractic, and the goal of the program at Yale will be to conduct rigorous academic research into alternative medicine. In any event, Yale’s program is still expanding and, according to its website, is pretty limited to helping physicians and medical students improve their own practice by teaching people skills. Any plans for research are well into the future. Read your own “cites” before using them as an argument.

I have no problem believing that Dr. Novella said this because it’s a mantra of those involved in skepticism. That said, as an academic physician, he certainly knows a good study when he sees one because he cites them all the time. “Studies” based on anecdotes are not good studies; “studies” that don’t control for such things as the placebo effect are not good studies; and “studies” that cherry-pick data so that they show what the author wants to show are not good studies. Novella knows this, which is why he dismisses these “studies”.

First of all, can you please give me a cite that the VA is offering chiropractic as a system-wide option? I don’t mean as a trial at certain hospitals, I mean as a regular benefit that is offered to every eligible veteran? For that matter, can you give me a cite about what percentage of publicly-owned hospitals offer chiropractic to all patients, not just as a trial?

Second of all, just because all of these entities offer it (assuming they even do) doesn’t make it any more valuable. I’d be interested in knowing how many chiropractors use manipulation and other modalities specific to chiropractic, and how many keep it to heat, massage, exercises, and other physical therapy modalities.

That’s funny, because if you’re looking for anecdotes for people who got positive results from care they got from MDs, I’ve got a ton of those, too. Most of them required rest, pain medication, and a referral to a physical therapist or, in the case of a few of my friends, surgery. And I’ve met more than a few chiropractors who clearly don’t know their way around a human body and who I wouldn’t trust to give me first aid for a paper cut. So it works both ways.

Nice try, though.

Bullshit, I would say. Novella has never claimed acupuncture studies aren’t any good because they show acupuncture works.

Many acupuncture studies clearly are flawed (and alt med studies out of China in general are notorious for being overwhelmingly biased towards positive effects while the same modalities get mixed or negative results in Western studies - see Bausell’s “Snake Oil Medicine” for a detailed analysis of this phenomenon).

If you want to know what Novella has actually said about acupuncture (the conclusion being that any possible benefit of acupuncture is too tiny to have clinical significance), read this article.

And check out the Science-Based Medicine summary on acupuncture, which includes the following:

*"It is important to evaluate the literature as a whole to see what pattern emerges. The pattern that does emerge is most consistent with a null effect – that acupuncture does not work.

Controlled clinical trials of actual acupuncture (uncontrolled trials should only be considered preliminary and are never definitive) typically have three arms: a control group with no intervention or standard treatment, a sham-acupuncture group (needles are placed but in the “wrong” locations or not deep enough), and a real acupuncture group. Most of such trials, for any intervention including pain, nausea, addiction, and others, show no difference between the sham-acupuncture group and the true acupuncture group. They typically do show improved outcome in both acupuncture groups over the no-intervention group, but this is typical of all clinical trials and is clearly due to placebo-type effects. Such comparisons should be considered unblinded because patients knew whether they were getting acupuncture (sham or real).

The lack of any advantage of real- over sham-acupuncture means that it does not matter where the needles are placed. This is completely consistent with the hypothesis that any perceived benefits from acupuncture are non-specific effects from the process of getting the treatment, and not due to any alleged specific effects of acupuncture. In other words, there is no evidence that acupuncture is manipulating chi or anything else, that the meridians have any basis in reality, or that the specific process of acupuncture makes any difference.

More recent trials have attempted to improve the blinded control of such trials by using acupuncture needles that are contained in an opaque sheath. The acupuncturist depresses a plunger, and neither they nor the patient knows if the needle is actually inserted. The pressure from the sheath itself would conceal any sensation from the needle going in. So far, such studies show no difference between those who received needle insertion and those who did not – supporting the conclusion that acupuncture has no detectable specific health effect.

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study the smaller the effect, and the best-controlled trials are negative. This pattern is highly predictive of a null-effect – that there is no actual effect from acupuncture."*

As I’ve said before on the Dope about chiropractic, there is evidence it may help some people with musculoskeletal pain, although not any more than other hands-on modalities like massage and forms of physical therapy. Where chiropractic fails is in its embrace (by many chiros) of quackery like naturopathy and homeopathy and gadget fakery, its opposition to quality evidence-based medicine (about half of chiros oppose vaccination, for instance), the insistence of many chiros that they are qualified to treat diabetes and other internal medical disorders, and its use of neck manipulation (rare but devastating strokes and death may result).

Heck, I can find dozens of cites. I tried to pick one which I thought people would have the fewest quibbles to and one which was generally accessible without the need for a special subscription.

Wikipedia

Yeah, I wouldn’t trust either of these guys. What would they know about science or medicine?

If you are interested in the issue with many of these studies on acupuncture and chiropractics, check out Mark Crislip’s various podcasts including his Quackcast on Supplements, Complementary and Alternative Medicine (SCAM).

Yale’s School of Medicine has over 2000 full-time professors and 2000 part-time instructors. While I don’t know when Dr Novella started at Yale, since 2006 the school has been teaching acupuncture. So to assume he speaks for the University, the staff, or anyone other than himself… is seeing what isn’t there. The fact he has his own podcast, doesn’t make him an “expert”.

People that Novella has criticized that have become renowned in medicine:
>Sanjay Grupta, CNN medical expert, who is the assistant chief neurosurgeon for Grady Hospital in Atlanta. Grady is the largest hospital in Georgia and one of the largest in the country. Dr Grupta was under consideration for Surgeon General.
>Deepak Chopra, new age guru, former Chief of Staff at New England Memorial Hospital.
> Andrew Weil, new age author, one of the directors of the University of Arizona Healthcare system.
> Dr. Mehmet Oz, tv show host, a department head at New York-Presbyterian Hospital. New York-Presbyterian is considered one of the top 10 hospitals of all the US.

These individuals weren’t one of a crowd, but established some known expertise in their own fields long before becoming famous. Novella being an assistant professor or even a professor at Yale of all places, doesn’t make someone an expert.

Mentioning Dr. Oz is very relevant to this issue. Several years ago, Dr. Oz invited Dr. Novella on his show after several of Novella’s complaints against Oz’s program. In the segment leading up to introducing Novella, Oz even showed criticism of himself by Dr. Gorski (a.k.a Orac). But when the interview started, both Oz and his other guests clearly had Novella outgunned. That could be expected as it was Oz’s show. Possibly from this encounter, Novella was quick to throw his two cents into the discussion months later when Oz was criticized for even mentioning the arsenic levels Apple Juice. ABC News did a special report with their expert and former classmate of Oz’s, Dr.Richard Besser. Dr. Besser, the former head of the CDC, confronted Oz and said that he wasn’t qualified to talk about arsenic, testing, or any other issue that he wasn’t an expert in. He remind the viewers that the FDA has clearly said Oz was wrong. Like Besser, Novella mentioned the debate and took Oz to task because Dr. Oz apparently really doesn’t understand science. Two months later the Consumer’s Union, publisher of Consumer Report, along with the FDA released statements that validated Dr. Oz’s report. The FDA said they had “mistakenly” been deleting failing samples from their reports. From this new information, both the Consumer’s Union and the FDA asked parents to reduce their daily serving of apple juice until better research and regulations can be obtained. Dr. Besser had Dr. Oz back on the news and apologized to Dr. Oz…sadly laying the blame on the FDA who provided him with the original information. He later said on the day of the original broadcast he had been on the phone with the FDA all day before he confronted Dr. Oz; they told him Dr. Oz didn’t have the right results. Now did Dr. Novella ever apologize or produce a correction? I think not. Did he spend anytime collecting evidence from any authority beforehand at the time of his blog? No, I believe he just used his “expert” opinion.

As to what I remember of Dr. Novella making his observation about acupuncture, it was in a televised debate. I don’t remember who he was debating, so it might be hard to find a online recording or video. But in a similar vein he said on one of his blogs about a released UN (the World Health Organization) study that supported acupuncture…” The fact that the architects of this review are all Chinese and clearly relied heavily upon Chinese research is not relevant because of the documented bias in the Chinese literature. “He goes on to say that another study showed that 99% of the Chinese studies are positive toward acupuncture; this of course can’t be true. But missing it why he assumes that Lancet, JAMA, and the New England Journal of Medicine regularly print negative stories about modern medicine; I am not aware they do. :slight_smile:

And, to be fair, there is a school of “Ethical Chiropractic” that does nothing else.

You’re citing Deepak Chopra, Andrew Weil and Dr. Oz as “renowned in medicine”? Seriously? A laughable New Age guru, an alt med supplement huckster and Dr. Oz, enabler of weight loss scams and faith healing?*

Even Sanjay Gupta, “renowned” “medical expert” is not immune to criticism, though it’s unclear what he was criticized for.

Actually, that sounds about right.

*"…there is strong evidence that Chinese acupuncture studies are biased in favor of acupuncture. This evidence includes studies which have shown negative results of acupuncture research are almost never published, studies are often inaccurately reported as randomized when they aren’t, and systematic reviews often selectively search and report the literature in ways that are favorable to acupuncture. Yet another study has now been published which confirms that Chinese researchers simply do not produce or report negative results for acupuncture.

Yuyi Wang, Liqiong Wang, Qianyun Chai, Jianping Liu. Positive results in randomized controlled trials on acupuncture published in chinese journals: a systematic literature review. J Altern Complement Med 2014 May;20(5):A129

This review found 847 reported randomized clinical trials of acupuncture in Chinese journals. 99.8% of these reported positive results. Of those that compared acupuncture to conventional therapies, 88.3% found acupuncture superior, and 11.7% found it as good as conventional treatments. Very few of the studies properly reported important markers of quality and control for bias such as blinding, allocation concealment, and losses to follow-up."*

Novella doesn’t ask us to believe him based on his job title. He supplies good evidence and relevant references to support his views. I’m not sure why you think denigrating his medical qualifications debunks his statements about alt med or disqualifies what Science-Based Medicine has to say about chiropractic.

*The Oz show’s mistakes in analyzing juice samples are not excusable on the grounds that a small percentage of samples were later found to have elevated arsenic levels.

I listed several individuals that had achieved some unique position of importance in their field before, and ever after, their fame. Simply being one of 4000 doctors at Yale isn’t really a gauge to bestow “expertise.”

I am sorry you don’t pick up on sarcasm. None of the conventional “peer-reviewed” Medical magazines here or in the UK, ever seem to print articles that goes against field. Why a double standard? Recently last year JAMA printed an article explaining that chiropractics do have a better track record with low back pain than conventional medicine. While it is noteworthy to have something like that admitted in a AMA publication, the fact that the same information could have been obtained from the AMA records presented into evidence in the Wilks v AMA (1987) more that 25 years ago, tends to show that the AMA doesn’t say nice things about alternative medicine often.

Define “small percentage”? The original FDA study said no apple juice had high arsenic levels. After being given ‘a heads up’ by Consumers Union about their research, the FDA noticed that 8 failing samples had been deleted. That was 8 out of 70 samples…or around 11%. Consumer Union’s research said 10%. Consumers Union/Consumer Report didn’t say Dr. Oz was wrong, the FDA eventually said he was right, and as I listed, Dr. Richard Besser… former head of the CDC… also said he was right. No matter how you look at it, 10% isn’t a truly small number. :slight_smile:

Coincidentally, I saw this article from Skeptical Inquirer in my Facebook feed this morning. I think it’s very relevant to the discussion at hand. It’s called “Why Bogus Therapies Seem to Work” and it goes into some detail about why people think SCAM therapies work.

In any event, the goal of the scientific skepticism movement, at least within the context of medicine, is to prove or disprove through empirical evidence from studies based on falsifiability, verifiability, and reproducibility the efficacy of a particular treatment. In other words, they want hard, quantifiable data before they will accept a claim. “This works because I say it does” doesn’t cut it, nor does “It worked for my friend, so it’ll work for me, too”. “Treatment X worked in y percent of patients, while a placebo showed no statistical difference” works.

It’s also worth noting that Drs. Chopra, Weill, and Oz have become very, very famous and very, very wealthy from peddling their bullshit. Dr. Oz, in particular, will shill for anyone who will pay him and he recently came under fire at a congressional hearing because of this. My own mother was taken for almost $100,000 by some otherwise legitimate MD for “stem cell transplants” that did nothing to improve her multiple sclerosis; if anything, she’s worse, but I don’t know that it’s due to the “transplants”.

If it’ll put a buck in someone’s pocket, it’s worth thinking twice or three or four or six times about.

I’ve had that excellent article bookmarked for years, and send out the link to anyone who sends me a dose of woo.

First, I don’t watch Dr. Oz, but I did watch the congressional hearing. At no time did Dr. Oz say he was paid to support products and NOBODY said he was. Your NBC article doesn’t claim that either. The whole discussion was if it was “ethical” for Dr. Oz to promote products that had little scientific support and just have Dr. Oz’s personal feeling. As for the subject matter, of all people to talk about ethics, Senator Claire McCaskill isn’t one of them. After establish she had neglected to pay $500,000 of taxes on her personal plane that was used at taxpayers’ expense, she got lucky her 2012 opponent made a stupid statement about rape that killed his campaign.

If we really want a government that works efficiently, should the Subcommittee on Consumer Protection, Product Safety and Insurance, that McCaskill chairs, not be addressing GM, Merck, or any number of the manufacturers that have produced items that have lead to innocent deaths? In all do respect, I think the worry that dieters are being mislead to drink green tea is slightly more hype that substance. :slight_smile:

[QUOTE=wissdok]
Simply being one of 4000 doctors at Yale isn’t really a gauge to bestow “expertise.”
[/quote]
What is with your continued obsession about “expertise”? There are no PhD programs in recognizing quackery, but a solid medical background and knowledge of how to evaluate the scientific literature goes a long way. Your insistence on attempting to denigrate Dr. Novella does not obscure your inability to a) challenge the evidence presented in his articles and conclusions relating to acupuncture, or b) refute the evidence that much of chiropractic is useless and potentially harmful woo.

I’m sorry you’re unable to admit you were wrong about Chinese acupuncture studies being overwhelmingly biased towards positive results.

Utter nonsense, seeing that mainstream therapies/drugs are constantly being reevaluated and sometimes discarded on the basis of new evidence. The same cannot be said for chiropractic treatments, homeopathy, acupuncture and other woo.

Unfortunately, I doubt any of this will change the mind of someone who apparently views Deepak Chopra as a towering figure in the world of medicine. :dubious::smack:

You may not have noticed this, but we have government agency and Congressional committee oversight of such things, and extensive regulation of medicine and the pharmaceutical industry. What we don’t have is any remotely comparable regulation of woo (supplement industry lack of regulation under DSHEA is but one example).

Responding to woo’s deficiencies by pointing a finger at evidence-based medicine and in effect saying “they do it too” is not just inaccurate, it’s a fallacious and invalid defense of woo.

I don’t know if Dr. Oz is paid directly for endorsements. However, Dr. Oz’s production company, OzWorks (as well as Oprah’s production company, Harpo Productions) gets a cut of the ad revenue on his show. Many of the products advertised are products that Dr. Oz endorses.

Sorry, it’s quackery, straight up.

Last year, SWMBO was having back issues. I tried to get her to go see a real doctor, but a friend talked her into going to a chiropractor. Did the X-ray, the whole 9 yards. After a month of treatment, she was getting worse, not better and finally went to a real back doctor.

Turned out that she had a broken back. Fracture between L4 and L5, which wound up requiring major surgery to pin and refuse. The chiro was making it worse, not better. I’m not a doc, but even I could see the problem on the X-ray, which makes me ask why the chiro didn’t.

I seem to miss where I degraded Dr. Novella. All I have said was… he shouldn’t be proclaimed an expert. Just because you may love him, doesn’t make him an expert. Simply proclaiming things you don’t like as “quackery” don’t make you( or him) an expert. Again Yale School of Medicine, where Novella teaches, has acupuncture classes…if Yale thought he was an expert, why do they teach acupuncture? Surely his “expert” opinion would sway the leadership at Yale.

Another colleague of Dr Novella often cited in quackery discussion is retired Dr. Stephen Barrett who runs “Quackwatch”. While he is clearly education with a doctorate from Columbia University and a man who should be respected, the courts have repeatedly said that simply being a consumer advocate doesn’t qualify someone as a “expert”. The term expert is bestowed on someone by an authority within the field of study. Neither Dr. Barrett, nor Dr. Novella have ever mention an authority that named them experts. In fact, unlike Dr. Barrett, I personally have never heard Dr. Novella say he was anyway.

I never said they weren’t, the simply fact is… that is what medical, industrial, or trade journals do. For Dr. Norvella to say “I’m shocked, shocked to find that gambling is going on in here!” is very insincere. The stories of faulty medicine, bad techniques, or criticism against medicine are not the hallmarks of either JAMA or New England Journal of Medicine. How many drug recalls can be traced back to published articles? Did shock therapy and lobotomies come to the end because of an article? The accepted focus of all trade journals is to market what is coming in the industry, not to criticizes every aspect of the industry.

Again you are off target. I clearly said that there were more important subjects that committees in Congress could be dealing with. While popularizing dubious weight-loss programs may be questionable, there is an assumed rule of prioritizing issues over their importance. Really did Congress ask Dr. Oz to appear because of the subject or just the face-time on television for the committee? If they invited the head of Merck or Pfizer to appear, would anyone have noticed?

[QUOTE= Qazwart]
Many of the products advertised, are products that Dr. Oz endorses.
[/QUOTE]

I cannot speak for all products mentioned on Dr. Oz show, but the products mentioned in the congressional hearing were not paid advertisers. That was made clear in the discussion.

Oz says he doesn’t get paid for product endorsements, and actually claims they aren’t endorsements at all, which is a bit of a stretch.

"McCaskill showed a clip from one of Oz’s commercials in which he says, “It’s green coffee beans, and when turned into a supplement, this miracle pill can burn fat fast. It’s very exciting and it’s breaking news.”

http://www.wjla.com/articles/2014/06/dr-oz-grilled-by-lawmakers-over-potentially-deceptive-product-endorsements-104212.html#ixzz37fFO60Wj

Oz has called Garcinia cambogia “a revolutionary fat buster”.

Sales of neti pots spiked tremendously after Oz touted them on his show.

Oz’s show is potentially worth tons of money to sellers of supplements and products. And people tune in to see what the next “revolutionary” supplement will be, which boosts ad revenues, and in turn makes sure Oz keeps getting paychecks and media attention.

Nope, it’s the evidence (which you ignore) that does that.

A number of med schools have sunk to teaching or offering woo. It’s big business and they either want to get in on the action or at least be seen as being sympathetic to what some patients want. It doesn’t mean such therapies work as promised. Arguing from popularity or based on what an “authority” says doesn’t wash if the evidence isn’t there.

Barrett is a good example of a quackery debunker whose enemies concentrate on attacking him personally and denigrating his qualifications, while ignoring the accurate, detailed and well-referenced articles that Quackwatch produces.

I refer you to a favorite altie meme, that of Vioxx - taken off the market thanks in part to journal articles and criticism within the medical community.

Yep, we haven’t achieved world peace yet, so everything else should be off the table. :dubious:

You are way, way too impressed with dubious authority figures, and pay way too little attention to solid scientific evidence.

As others have noted, Dr. Oz gets a cut of the advertising revenue from the show, and he most likely receives income from the production company and/or the distributor. Since advertising revenue is directly related to audience, and his is pretty big and demographically desirable (women 25-54), manufacturers of woo are eager to advertise on his show. It’s a quid pro quo: You deliver the audience, we’ll deliver the revenue. By mentioning the products on his show, he’s endorsing them, and even if he doesn’t tell his viewers his approved sources, he’s still attaching himself to them and he’s profiting handsomely from them.

We do have that. It’s a highly specialized agency called the Food and Drug Administration, and they have the authority to require that a drug have what’s called a “black box warning” for dangerous side effects; require certain special conditions, such as requiring that users of known teratogenic drugs be on contraception and that female patients be tested monthly for pregnancy; or the drug can be taken off the market entirely if it’s deemed not to be safe and effective.

Conversely, dietary supplements don’t have the same protections; the best anyone can do is hope the Federal Trade Commission can make a case for fraud and deception if they don’t work. This is after the fact, by the way; they can’t prevent a product from entering the marketplace like the FDA can. And therein lies the rub. A drug like Belviq requires a crapton of testing and development before it can be approved, and it can still be taken off the market if there are problems with it. A supplement like Garcinia requires no such testing and if there are problems, the manufacturer might only get a slap on the wrist. Yet Dr. Oz is perfectly happy to endorse Garcinia as this week’s “miracle” to the hordes of women who are begging the manufacturer to take their money.

And you’re probably asking yourself “Well, what’s the harm? Garcinia is just mangosteen, and mangosteen is a fruit. How bad can that be?” It’s probably not harmful in and of itself unless the fruit is tainted with something that shouldn’t be there. (BTW, the links go to food products, which the FDA regulates, not to supplements, which they don’t. My point is that these things are sometimes tainted with drugs, pathogens, or allergens.)

The real problem is that the supplements that Dr. Oz pimps don’t work at causing weight loss or anything else, and he’s deluding his audience into believing that they do. The only real solution for obesity is following a healthy diet and exercising. Any drug that helps weight loss simply makes you not hungry so you don’t overeat; it’s also used in conjunction with a medically-supervised diet program. It’s not to make you magically lose weight while you keep stuffing your face with junk.

Caveat emptor, my friend. Caveat emptor.

Not to mention, legitimate weight-loss drugs, like topiramate, or phentermine, are PRESCRIPTION drugs. Anyone taking them will be under a doctor’s care already, and not going to a TV doctor for advice.