(Part Two)
by Mal Vickers
And so it was, I went along to RMIT’s Open Day on August 14, 2011, with my camera, voice recorder and some prepared questions. As any good skeptical researcher would do, I went searching for the evidence and for the experts that might help me find it.
Surely, if there is any up-to-date science behind chiropractic the leaders of chiropractic teaching in Australia would know? Would I be the one to eat humble pie and change my mind if the science had come of age?
The Chiropractic Department at RMIT is housed on the Bundoora Campus, Bundoora is a suburb in the outer north of the Melbourne metropolitan area.
As you would expect of any university open day, there were the usual information booths, people helping with directions and information, tours of the facilities etc. I took a tour of Building 213, the Chiropractic Clinic. On the outside, the sign said Building 213 was the School of Health Sciences, Teaching Clinics. Although once you’re inside, a different sign states RMIT, 
Complementary Medicine Clinics. (How does that song go? ‘things that make you go, hmmmmmm’) Interestingly, the building is also shared with RMIT’s Chinese Medicine Clinic.
Inside the many chiropractic treatment rooms, were ‘trigger points’ charts. They look like a cross between genuine science-based anatomical charts and reflexology charts. I don’t wish to get to side-tracked, so if the reader desires, you can side-track yourself and read about the chiropractic idea of ‘trigger points’ on Wikipedia.
It was rather confronting to observe pseudoscience being so openly displayed at a trusted, government-funded university, where anyone can come and pay for a ‘treatment’.
Additionally, this chart about spinal function in many of the treatment rooms. It purports to show a decline and then restoration in spinal health with frequent visits to a chiropractor.
There was also this poster, which attempted to raise concerns about the mythical ‘subluxations’.
Enrol Up, Enrol Up!
In Building 201, I sat in on a lecture given by the Chiropractic Head of Discipline, Dr Tom Molyneux. The talk was aimed at prospective chiropractic students and their parents. The list of units that the chiropractic students are expected to complete was enormous. The impression was that students would become highly-skilled and knowledgeable. Did you know that chiropractic students are given the opportunity to do cadaver study? It’s actually a rare privilege generally reserved for students studying a medical degree as I understand it. Did you know that a full-fee paying RMIT chiropractic student can expect to pay around $20,000 per year to study?
Much of the talk was about the VTAC score RMIT would like prospective students to achieve before attempting to enrol in RMIT Chiropractic. Some of the lecture was about the outreach activities of the Chiropractic Department. Apparently, there are four chiropractic clinics in total across RMIT’s campuses and there was talk of an outreach program at an aboriginal community. It was all quite positive stuff about health and helping people. A number of the staff and senior students of the Chiropractic Department also contributed to the discussion.
Of course, I was interested in what wasn’t said. No mention was made of the historical controversies and risks of chiropractic and not a hint that students may be enrolling in a course which combines outdated ideas with the placebo effect. It’s no surprise, I guess.
After the speech, and as people wandered away, I found a quiet moment to approach Tom and engage in polite conversation. I introduced myself as a blog writer from the Australian Skeptics and asked Tom if he’d be willing to be interviewed. Tom was polite but firm in his answer, which was “No”. I was told that I would have to go through another channel, that being RMIT University’s Communications Office. Tom politely gave me the contact details for the office.
I’m still a little surprised at being unable to get an interview with RMIT’s chiropractors/lecturers. Aren’t lecturers fervently supportive of the idea of academic freedom? Would every Head of a university science department decline to be interviewed by a skeptic like me?
Oh well…it’s their choice. I left RMIT Open Day without an interview (note the irony). But the story doesn’t end there…I’m a little more annoyingly persistent than that. I went ahead and contacted RMIT’s Communications Office. They said I’d have to write my questions in an email.
I’d prefer to have a friendly and civilised face to face discussion rather than an exchange of emails; it looks like I don’t have a choice.
As you’ll note from my questions, they’re very much about chiropractic. I doubted that RMIT’s Communications Officer would be able to offer expert advice. I suspected that they would need to forward my questions to the people in the Chiropractic Department anyway.
Nevertheless, on Monday August 22, I emailed my questions (see below), together with a polite preamble, to RMIT’s Communications Office.
My questions covered the five areas presented in my last blog post on this topic.
Subluxation
The 2010 RMIT position paper on subluxation says (in part):
‘…in that it emphasises the need for clinical evidence to support a diagnosis that leads to intervention by adjustment.’
The link to clinical evidence is made; however the statement does not actually reference any scientific evidence. Would you say Chiropractic subluxation (or VSC) idea is scientifically well established or not well established?
Chiropractic and Vaccination
Recently there was a news report that claimed many of the professional supporters of the Australian Vaccination Network are chiropractors. Note that the AVN is an anti-vaccination organisation. [Heraldsun news report.]
My questions are:
Are the principles of chiropractic inherently antagonistic to vaccination?
Do you have any ideas as to why so many chiropractors are supporters of an anti-vaccination group?
Does RMIT Chiropractic have a policy on vaccination?
Will this report lead to any changes with the teaching of chiropractic at RMIT?
Chiropractic to Treat Children
I have information that RMIT Chiropractic had opened a Paediatric Clinic. A brochure currently available at the Bundoora Chiropractic Clinic (Building 213) says that ‘a paediatric clinic has been established’ and I understand an RMIT newsletter made the same announcement. I’m sure you are also aware that campaigner for science-based medicine Loretta Marron ,wrote to the health minister Nicola Roxon asking for the RMIT Paediatric Clinic to be closed.
I recently did a quick tour of Building 213 as part of RMIT’s 2011 Open Day. I saw no direct evidence of a Paediatric Clinic, although I couldn’t get any direct answers from staff in relation to use of the facility to treat children.
My questions are:
Could I get RMIT’s reaction to Loretta Marrons request?
Also, if the Paediatric Clinic is an ongoing entity, I’m interested in knowing how active it is and what conditions are being treated?
The Better Health Channel Website
The Victorian Government Department of Health has a website called The Better Health Channel. It has a page about chiropractic.
On this page the information stated the following:
‘….produced in consultation with and approved by RMIT University.’
The page also says:
‘Scientific studies have shown chiropractic can be helpful to assist with a range of disorders, including: Back injuries, headaches, lower back pain, migraines, period pain, problems with posture, sciatica (shooting pains in the leg), tinnitus (ringing in the ears).’
Also:
‘Chiropractic and Children.
Chiropractic care for pregnant women, nursing mothers, babies and children is offered by chiropractors with additional training in this field. Chiropractic care about the neck is not suitable in children with Down syndrome and some other conditions. Chiropractors typically work with very young patients in association with maternal health nurses and accept referrals from general medical practitioners (GPs).’
The UK’s General Chiropractic Council commissioned the Bronfort Report to look at the scientific evidence supporting chiropractic (2010). The Bronfort Report only used evidence from well-conducted, randomised, clinical trials.
The Bronfort Report contradicts what is stated on the Better Health Channel Website; sciatica was placed in the inconclusive category. Premenstrual syndrome is also mentioned in the inconclusive category and tinnitus is not mentioned at all.
The Bronford Report does not suggest the use of chiropractic to treat any conditions typically associated with pregnant women, babies and children.
I agree that the findings of the Bronfort Report also claims:
‘Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.’
My questions are:
Does RMIT Chiropractic stand behind the claims made on the Better Health Channel Website? In particular, I’m concerned with conditions for which there appears to be little evidence and the claim that ‘chiropractors typically work with very young patients’.
Informed Consent and Risk
A recent article in the UK’s Guardian Newspaper, noted that many chiropractors didn’t regularly inform patients of the risks associated with chiropractic manipulation of the neck.
My questions are:
Although the survey was done in the UK, do you think the same results would be found in Australia? I’m interested to know if the teaching of chiropractic has changed in relation to the survey’s findings?
Further Comments:
Please note that by asking these questions I’m not suggesting that science-based medicine is perfect or beyond criticism. I’m also not suggesting that science has established all the facts. I also understand that chiropractors give practical, healthy, lifestyle advice to patients i.e. diet and exercise. Similar advice is also given by other healthcare professionals.
Skeptics are particularly interested in critical, unbiased evaluation of available evidence. That’s why I’m approaching RMIT. I seek the facts and to acquire the best information from one of Australia’s leading chiropractic educators.
I had a suspicion right from the start that RMIT wouldn’t like my questions and might find it easier to say nothing. Who would want to bother with questions from a skeptical amateur blog writer anyway? Thus, I added this to my preamble.
I don’t wish to sound rude or make this difficult, as it is you (and whomever you find) who would be helping me, however, I think a month would be a reasonable timeframe. Although, something sooner than that would be fantastic. If I don’t hear anything back in that time, I think it’s reasonable to assume no-one is willing to respond.
After a gentle reminder, I was surprised to see an email from RMIT in my inbox on the 15th of September. I’ve deleted names but other than that, the full text is shown.
In relation to RMIT’s chiropractic clinics, I can pass on the following:
RMIT operates four chiropractic teaching clinics. The largest, on our Bundoora campus, sees patients of all ages. The small number of paediatric patients are treated only by experienced registered chiropractors. The chiropractic treatment offered to patients is directed toward their musculoskeletal conditions.
I responded the next day:
I must say I’m a little dismayed and disappointed by the short answer. Perhaps one question where I asked if the Paediatric Clinic is an on-going concern was loosely answered. Although saying that treatment is only directed toward musculoskeletal conditions isn’t definitive.
The founder of Chiropractic, D.D. Palmer, said that:
“A subluxated vertebra… is the cause of 95 percent of all diseases. The other five percent is caused by displaced joints other than those of the vertebral column.”That’s why I’d prefer a more detailed response as to the different types of conditions for which children are referred and given chiropractic treatment.
I also asked other important questions about; patients being properly informed of risks, the information provided to a government website and the association between chiropractors and the anti-vaccination lobby.
Is that the only response I’m likely to receive?
I appreciate the time you’ve taken so far and I am genuinely interested in getting RMIT’s views on recent concerns about chiropractic.’
Since then, there’s been no further communication from RMIT’s Communications Office (again, note the irony). I believe I’ve given them ample time to respond. I think that a month is a reasonable and generous amount of time. It’s disappointing because I thought my questions were worthy of a reply, well-researched and of public interest.
What do you think? Is the reply I got from RMIT satisfactory? Add your comments below if you wish.
Update: August 2012
Choice Magazine published an excellent article on Chiropractic titled: Can a chiropractor replace your GP?
Update: April 2013
Macquarie University in NSW announced it would be dropping its Chiropractic program from 2015. It appears that chiropractic is incompatible with Macquarie University’s new investments in teaching health sciences.
Update: May 2013
Australians spent $10M on chiropractic through the taxpayer funded Medicare system in 2012.
RMIT Open Day is the 11 August, 2013. I say go along, ask questions.
The former Head of Discipline, Chiropractic, RMIT, Phillip Ebrall, is now setting up a ‘Bachelor of Science’, Chiropractic degree at the Central Queensland University (Mackay) due to commence 2012.
It will be interesting to see if he recommends his own text book for 1st year students, as he did at RMIT.
I find your research and article very interesting. My husband, with chronic lower back pain caused by compressed and bulging discs finds his chiropractic treatment very useful. I, on the other hand have grave reservations. I had two whiplash injuries. My neck was painful for years and the medicos only offered a form of neck traction or painkillers. One chiro then gave me a relatively successful treatment with the “gentle” form of spinal manipulation. Years later and my neck “locked up”. My excellent doctor was mystified. After CAT scans, antibiotics and acupuncture I went to a local chiro in desperation. I was not informed that there could be any dangers and the treatment was, quite frankly, brutal. After two sessions I stopped because my neck wasn’t just still locked up, it was so painful. I wasn’t informed by him at the initial consultation that it could be detrimental or even dangerous! I should mention that one early consultation with another chiro who has since gone on to study medicine to become an osteopathic specialist DECLINED to treat me as he felt manipulation was risky considering my medical history.
I feel that chiropractic has its place but am highly sceptical about the treatment of children and some of the claims made e.g. pms, tinnitus etc. Certainly patients should be better informed about any inherent risk with aggressive neck manipulation.
Hi Mary-Anne, thanks for the kind words. Using chiropractic to treat children without good solid scientific evidence that it’s effective is certainly a worry. Skeptics try to look at things from an objective, scientific point of view, rather than an individualistic point of view. It could be that a few people will comment here saying that chiropractic was effective for them, like it was for your husband. However it could be that those people were just lucky, or may have got better in any case, the human body is actually pretty good at healing itself – I think it’s best to look carefully at the numbers that come out of a proper, placebo controlled, randomised double blind trial.
Or possibly a systematic review, take this one for example 🙂
http://www.ncbi.nlm.nih.gov/pubmed/21952385
However, it’s the job of your local doctor to keep up with the research. That’s my advice, find a good local medical doctor.
Follow the money: “… a full-fee paying RMIT chiropractic student can expect to pay around $20,000 per year to study?” ‘Nuff said.
Wow, this is fantastic. I admire your determination to pursue these slippery characters.
I fear such difficult questions need to go out to the wider health bureaucracy unfortunately. How can this be allowed;
(http://www.youtube.com/watch?v=wxDCLg_0_KI)
Phillip Ebrall, mentioned by Loretta above, has a website where you can check ‘three recent papers I like’ (all authored by himself).
Check this excerpt out, with reference to teaching about the ‘Vertebral Subluxation Complex’:
Inspired by a visit to Disneyland this paper explores the challenges associated with the need to teach something that may not exist. It reports lessons learned by viewing a successful commercial illusion that have capacity to inform a pedagogical approach to abstract objects.
http://www.ebrall.com/ebrall.com/recent_papers.html
I think a month is ample time to politely answer your reasonable questions. Given that there is a lack of evidence of efficacy for most conditions, that chiropractic has well known risks and that the whole concept of ‘subluxations’ makes absolutely no sense in terms of modern medicine, you raised some important and valid points.
I too have great concerns about universities supporting pseudoscience in this way. I was therefore pleased to read yesterday that the University of Wales has stopped validating courses at the McTimoney Chiropractic College. This has been blogged in more detail by David Colquhoun and Andy Lewis (see below).
http://www.dcscience.net/?p=4766
http://www.quackometer.net/blog/2011/10/mctimoney-chiropractic-college-in-deep-trouble.html
So right Mal. It is human to seek relief from chronic pain even when firm evidence is lacking and this lines the pockets of some practitioners. Perhaps they have to recoup their twenty grand a year college fees! I feel that the first chiropracter who treated me was ethical in declining to treat my neck condition. The last (and last for me) chiropracter who told me that “times have changed” and there was little or no risk was a student at RMIT. However he did have me sign a disclaimer. I should have woken up then.
I’m learning Mal. I’m learning!
Thank you for your site. My new resolution thanks to you is to question and explore, not simply accept matters at face value.
Well done on an excellent article Mal!
The trigger points you mention are in fact a legitimate entity, though a little controversial in medical circles due to widespread hijacking by chiropractors and myotherapists who frankly murder what precious little science and reasoned clinical thinking we do have about them. I see many patients with severe trigger point pain, mainly because the diagnosis isn’t taken very seriously by others.
Naturally, as with all science that is adulterated by chiros, they didn’t come up with the idea, nor have they done any of the grunt work to establish the science that underpins our current thinking about myofascial pain.
Hi Mick,
Thanks for the kind words. I did a little checking into trigger points in preparation for the post, although, I struggled to find solid science, behind it. Thanks for the helpful clarification. What would be your opinion; is the use of these trigger point charts justified in a chiropractic clinic?
“…hijacking by chiropractors and myotherapists who frankly murder what precious little science and reasoned clinical thinking we do have about them…”
I can’t speak for chiros but in the interest of full disclosure, I am a myo who graduated from RMIT and can tell you that every single sliver of information that was delivered in our course was well referenced by recent, credible scientific sources. Our main prescribed texts included the likes of Brukner and Khan, Travell and Simons, Cook and Purdum, Werner, to name just a few. I acknowledge this post and comment were made going on 3 years ago now, but I’d just like to state that the science behind trigger point and pain referral theory is strengthening, not weakening, and the myotherapy treatment protocol is also strengthening, not weakening. Myos who graduated from RMIT are muscle specialists and had the importance of scope of practice repeated slammed into our brains. I’d be surprised and disappointed if I saw any myo attempting to practice outside of his or her scope or practicing anything that is not research backed.
I can’t speak for Mick and the post is about chiropractic so this is a somewhat off-topic question. However, just for interest sake, I’d like to know if you can give me a reference to a rigorously conducted clinical trial, (i.e. placebo controlled, randomised, etc) showing the efficacy of myotherapy for a well defined health condition that myotherapists claim to be able to treat?
I’ve already looked on PubMed but couldn’t find any such study, however I’m willing to look at good evidence if you have any?
greetings,i have only just found your informative site and have one point to make, you mention about anti inoculation policy in your report,but as a truth enquirer i drawn your attention to this subject which needs investigation as to the presence of mercury and other heavy metals that are said to be in these “preventative” jabs.
Thanks for your kind words about our site.
The reason that mercury and heavy metals “are said to be” in vaccines is because sources like the AVN continue to spread this disinformation in spite of all evidence to the contrary.
I suggest you look at this article by Dr Rachael Dunlop.
http://www.mamamia.com.au/news/vaccination-myths-busted-by-science-cheat-sheet-on-immunisation/
This subject does needs investigation – by you. The information is all freely available. You simply have to decide who to believe: health professionals, or irresponsible conspiracy theorists like the AVN.
thank you for your direct and prompt reply,
serious enquiry is needed in this and many other issues,
there is no greater gift than to see truths of the reality we inhabit,
may truth always prevail.
she of faith
Good on you for trying, but it appears RMIT has “clammed up” on you. I wonder if the $20,000 a year fee has something to do with the lack of openness and scientific enquiry at RMIT? On back pain, I am most impressed by UK studies showing 90% of acute back pain gets better in a few weeks no matter what you do (so long as you dont make it worse) and at 5 years in chronic back pain (without nerve inolvement) there is no statistically significant difference between surgery, exercises, no treatment, physiotherapy,chiropractic, osteopathy etc. In other words, dont waste your money or risk complications, get on with life. My own experience is a patient with back pain not resolving, had a CT scan which didnt show a disc prolapse, had some chiropractic vigorous manipulation a few days later, developed severe sciatica and a fresh CT showed a large disc prolapse! Since then my practice is to advise agaianst vigorous manipulation, agains any neck chiropractic at all, and to accept some chiropractors do a very good massage, but dont believe any of the “theory” they mention at all!
Nothing like a crusader (does she wear a cape) to spin a yarn to the world. Any university course has to be accredited by independant agencies to be approved in the first place. It has to be teaching safe reliable techniques and teaching practices. Chiropractic has been through numerous inquiries including a royal commission in New Zealand, and been vindicated in each of these inquiries. Why is there little research? They are not funded by the goverment and drug companies, and then it is difficult to get ethics approvals for research on people.
I think an interesting study would be seeing the cost to medicare of patients who seek medical care as their primary source of health care (Sickness mangament) as opposted to those who seek Chiropractic care (health care) and to see what is more costly on yours and my pockets.
Why did the caped crusader target only one of the Chiropractic teaching facilities in Australia? Is there a difference or does the caped crusader have an axe to grind? A misdiagnosis by an ‘alternative health practitioner’ (who was not a chiropractor anyway), appears to be a greater problem than a misdiagnosis from a medical practitioner. Sounds like the medical profession is threatened to me. Have you ever thought that the only reason Chiropractic is so big in Australia might be due to an inadequate medical system? Surely if Medicine was so all encompassing there would be no need for any other form of health care.
As a medical practitioner Im open to all kinds of therapy and care, and I send all of my back pain and neck pain patients to Chiropractors because i want them to get better, and Chiropractors are better trained and equiped to do so. I have happy patients and don’t have an office full of conditions that medical care does poorly with, which leave me to time to get on and work with the problems and illnesses that medical care is best at.
Incidently Never heard a member of the Chiropractic profession putting the life of a child at risk and death like they have just done at the Royal Womans hospital. Come-on you caped crusaders how unscientific was that debarcle. I suppose you want to close all womens hospitals next???
“Caped crusader”? I’m not quite sure what you’re on about. If you followed the link here from AusDoctor and have presumed that the post was written by Loretta Marron, it wasn’t – and I’m of the male gender.
Even if Loretta does wear a cape, which to my knowledge she doesn’t, what does that have to do with the topic of the post? Should chiropractors claim to be able to treat children? Should chiropractic clinics be located in government funded universities? etc..
If you are a medical practitioner, then yes, you are entitled to refer patients where ever you wish, I didn’t suggest you couldn’t.
“Why did the caped crusader target only one of the Chiropractic teaching facilities in Australia?” Because RMIT claim: “RMIT is a leader in chiropractic tertiary education….” I quoted this RMIT claim in the previous post on this topic.
“Incidently Never heard a member of the Chiropractic profession putting the life of a child at risk and death….” of course the death of a child is deeply regrettable and where people are involved I would suggest mistakes are inevitable. My understanding of this terrible incident is that a full and public investigation is being done.
You say “never” you might like to investigate the sad case of Lyna Epping (Aged 8)
http://www.chirobase.org/05RB/AYOR/00p.html
James Turner (Aged 11)
http://www.chirobase.org/08Legal/turner.html
There is also a study involving 34 children aged between 3 months and 18 years detailing adverse reactions to spinal manipulation, the abstract can be found here:
http://pediatrics.aappublications.org/content/119/1/e275.abstract
Lynda Epping case is 50 Years old!!!! Turner case of an 11yr old, I dont think very many people would do Xrays of a child of that age with non-specific chest pain after swimming. I dont know if you have any clinical training, or your just an arm chair critic, It appears just unfortunate that this clinician was a Chiropractor. This case you cite doesnt say if the Chiropractor was found guilty, only one side of the case. Your ref to 34 children with adverse reactions to spinal manipulation doesnt say that any of the cases were involving a Chiropractor. At least I highlighted a case that was recent, and appears completely inexcusable at all professional levels.
The thousands of patients that are seen by Chiropractors with no adverse events, including elderly and children, would attest to a very high safetly record for that profession. Perhaps you should go after more worthy allied health practitioners, and faith healers, rather than bleating about registered health professionals.
Ive also diagnosed life threatening cases missed by other medical practitioners, and the longer you are in this profession Im sure I have missed or will miss a case one day. Thank God (dont know if I can use this word with a skeptic) the professionals in my area work together and dont try to outdo each other or crucify each other. We try to all work together for the benefit of the patient.
You suggest that “Mistakes are inevitable”, and I agree with you about that, but it seems to be these are ok when done by the medical profession, where there appears to be a certain amount of protection…. a recent case is an orthopaedic surgeon drilling through a clavicle into the subclavian vein resulting in the death of a 30’s+ male from blood loss and air embolus. He was unfamiliar with the drill. Dont think he was in any trouble, rather, there was a recommendation to the respective colleges to be aware of this incident.
I am just ONE family doctor. In my career I have now seen two patients misdiagnosed by chiropractors with catastrophic results. Both had spinal tumours. The first patient died. The second has had horrible spinal surgery and is left permanently crippled. The chiropractors treated their spinal pain for months and years …before a proper doctor (?me) made the correct diagnosis. Multiply my experience by all the doctors out there and we have a national disaster.
Sorry to burst your bubble champ, but as a chiropractor i have had at least half a dozen patients with tumours missed by their G.P and absolutely countless patients with misdiagnosed LBP. Multiply that by every chiro out there and I get the strong impression that G.P’s are generally under qualified (if not completely incompetent) in musculoskeletal conditions.
Don’t think it is only you picking up my mistakes, I am picking up yours too.
[Edit by Admin] Hell Adam! Who do you think you are??? Everybody knows all doctors are perfect and never make mistakes…and all chiropractors are dreamers who pray to the god of subluxations. With all due respect, I would contend the pilot’s training makes him more useful in the cockpit than the air hostess ….even if they have both been flying for the same number of years.
[George, please read the comment policy – Admin]
Hi George, I am a medical reporter from ABC TV. I’m researching a story on Chiropractic. I am interested in talking to you about your experiences. If it’s ok, please email me on demasi.maryanne@abc.net.au as soon as possible. Many thanks.
Hi Dr Q,
Personal experience is a fairly low level of evidence. If a man of your experience has seen only 2 chirocatastrophes, multiplying that experience by all the doctors “out there” does NOT represent a national disaster, just some very unfortunate for those involved statistical ‘noise’. I’m all in favour of grilling the claims of chiro. But … let’s not add breathless hyperbole of our own.
Point well made and taken.
That said, my experience means something and I will leave the readers to make of it what they will. Australians are marching en masse to “therapists” of all colours. A small number of them will actually have a serious illness. Those individuals are doomed to sufer the consequence of seeking poorly qualfied advice. “Buyer beware” seems an unacceptably harsh doctrine in such cases.
(PS How is Grendel?.)
Hi Dr Q,
He’s well thank you, fairly ‘armless, but persists in mixing with the blonde thugs across the lake. I worry about him. Regarding the restless hordes of Australians – I think ‘en masse’ is the key. Being social monkeys we like to be in a comforting group, even as we thunder towards the Gadarene (I know, they were demonised pigs) cliffs. We’ve all got the vote, consumerism is rampant, Cassandra is ignored, cultivate our contrarian gardens.
Dear Mal,
Thank you for your efforts in seeking clarity from the charismatic charlatans of chiropractic (That being said, they aren’t all guilty of disingenuous conduct or the delusion of magic fingers).
Informed consent needs to include the explication of risks (from roentgenography and manipulation both) as well as the evidential basis of a proposed treatment – chiropractors operating outside these fundamental rules are in violation of the principle of primum non nocere.
The responses you have (and have not) received reflect very poorly on RMIT. I wouldn’t recommend anyone seeking an education in any realm of science to a university so dismissive of scientific principles and lacking in transparency.
Dear Dr Mathew,
Thank you for your kind comments and I completely agree with your summary.
Mal – wouldn’t want to dissuade you from continuing to ask questions but, speaking as a journalist, your account says more about the modus operandi of large institutions’ media/communications staff than any obfuscation by chiropractic. The standard rigmarole these days is to a) be told by your potential interviewee that you need to go through the media office; b) duly contact said media office to request interview; c) acquiesce to their demand that you put your questions in an email; d) wait; e) receive a “response” that fails to answer any of your questions.
Unfortunately, that pattern stands regardless of whichever university department, government agency or large corporation you’re trying to elicit information from.
Hi Kate,
I’ll bow to your greater experience and I hear your pain. It’s not stopped me from asking questions. I’ve just been through the same rigmarole again – see recent post about Chinese Medicine at RMIT.
http://vicskeptics.wordpress.com/2012/09/26/rmit-open-day-2012-traditional-chinese-medicine/
Thanks for the comment.
As someone who studied chiropractic, and left the “profession” as soon as I graduated, I am happy to see that discussion of chiropractic’s flaws is making its way into the public arena. From day one, I felt uneasy about chiropractic, but not about the course. The cause was HARD. Really hard. We were loaded up with 7 subjects a semester – and were learning real science (biomedical science, anatomy, physiology etc) for the majority of it. The chiropractic “science” was actually quite a minimal portion. Indeed I would suggest that my anatomical knowledge far outweighs any of my friends’ who studied medicine, physio and osteopathy.
The truth is that RMIT does teach “evidence based” chiropractic. I remember a female lecturer (I will not name names) being INCREDIBLY excited about a study which actually showed that muscle spindle activity was changed post manipulation (I can’t remember the name of the study). We were also required to undertake research of our own. There was a significant and real focus on evidence and research. This was met with genuine dissatisfaction by the majority of the cohort, but the university nonetheless persisted. I was grateful for this.
The problem does not lie with RMIT. They are doing their best. The problem is with the profession. My friends who sat alongside me, who learnt physiology, who learnt about informed consent, who learnt that subluxation theories are inherently flawed nonetheless went out into the “real world” and practiced as if it was 1930.
As a chiropractor, you can “hit and hope”, you can talk about the “innate intelligence” of the body, you can tell people they will get better. But as a student of RMIT’s chiropractic course, you were NEVER taught those things.
Most students came to the course already “knowing” what sort of chiropractor they were going to be. It is a shame that over the five years they could not see that as an evidence-based musculskeletal therapy, chiropractic would be much more beneficial. We should be the non-surgical spine specialists, like dentists are for teeth, and podiatrists are for feet. Unfortunately we are seen as quacks like reflexoligists.
I acknowledge that the posters in the clinic are a bad look. Most are simply “decorative” and are used as a very simple guide. Whilst somewhat misleading and deceptive, they do not represent the current thinking of modern, evidence based chiropractic. Having said that, the trigger point posters are actually quite handy, because despite the lack of credible scientific evidence, trigger points do exist. In fact, my greatest successes came from treating them. Nearly all of my patients with headaches had trigger points. Nearly all of them had their pain removed (note I did not say cured, or healed) following trigger point therapy.
I am with you 100% in relation to chiropractic paediatrics. While there is no evidence to suggest that it is dangerous, there is similarly no evidence to suggest that it is beneficial. The real danger is that some chiropractors will tell naive parents that their child’s “fever” is good for them, and that they should not listen to medical doctors. In no way am I suggesting that medical doctors get it right all the time, but as someone who “learnt” about chiropractic paediatrics in one semester, and walked away knowing nothing, I do not condone or appreciate it.
I hope that by reading this you will understand that the profession of chiropractic needs to be completely overhauled, not the university course (nothwithstanding the paediatric component). If everyone treated the way that we were taught at university, the profession would NOT have the problems it has today. Essentially, your sceptism should be aimed at the Chiropractors’ Registration Board (who are ALSO trying hard), but mostly at the Chiropractors’ Association of Australia. As the representative body for the majority of chiropractors – and thus the profession – you should focus your questioning on them
Thanks for your thoughtful reply ‘former chiropractor’. A few points.
The Australian Skeptics has contacted the CAA and raised significant concerns, see:
http://vicskeptics.wordpress.com/2012/12/20/a-letter-to-chiropractors-about-advertising/
Chiropractors themselves largely pay for the CAA’s operations through fees. I would suggest fee paying Australian chiropractors might have the greatest influence on the CAA, evidently Skeptics have no influence.
Australian tax payers significantly fund the teaching of chiropractic in universities, covering what is not covered by student fees. I think the public is entitled to some accountability, including asking if evidence-based healthcare is being taught. I think you and I are differ in our opinions as to what constitutes ‘evidence based healthcare’.
Skeptics think an evidenced based treatment is one where properly conducted, placebo controlled randomised trials show the treatment is significantly more effective than a placebo response and at least as effective as the best currently available treatment. The cost/risk, benefit equation also comes into it.
I don’t dispute that those teaching the chiropractic course at RMIT are good, hard working and knowledgeable people. Such good people should be able to demonstrate, rigorously, scientifically and openly, the benefits for the tax dollars they get, do you agree?
Thanks for your response Mal.
You will probably be surprised to know that RMIT often told us that the “evidence” for chiropractic was sketchy, and that the Cochrane reviews did not demonstrate that chiropractic was overtly favourable in comparison to other techniques. This is particularly so in relation to claims regarding asthma.
However, it is worth noting that placebo trials are inherently difficult for chiropractic treatments. Indeed, “Sham” procedures are nowhere near as effective a placebo as “sugar pills”. This is one excuse as to why the current level of evidence is terribly thin.
The point I am raising is that, despite your criticisms of RMIT, they taught students like me (who actually came to class, and paid attention) that more research was required, and that the profession would fail to survive should its practitioners rest on its laurels.
The Australian Spinal Research Fund is one initiative trying to remedy this substantial problem, however as the majority of practitioners treat their patients as if they were blind folded from the realities of modern science (a practice scoffed at by RMIT), I reaffirm my previous claim that the heat should be directed on the profession as a whole.
Even though I left Chiropractic after studying at RMIT for five years, I truly am grateful for the education I recieved. It is the profession itself that I despise.
It’s a damn, damn shame. I – like former chiro – was a chiro student. After 2nd year, I decided to pull out and head elsewhere. The major impetus for this was due to ‘real world’ practice observations, including one Chiro who claimed to be able to avert cancer thru judicious application of SMT.
I’ve often pondered why Chiro is in the state it is. As former chiro suggests, the courses are chock full of your typical biomed fare. Why then – upon graduation – do so many chiros fall afoul of nonsense? Worse yet…those few that *do* attempt to apply chiro rationally are hounded as heretics?
I think perhaps engendered cultural norms will keep chiro where it is for a long, long time. Which – as stated before – is a damn shame.
C’est la vie
Not sure where you get the idea that trigger points are a Chiropractic phenomenon. They are equally used by physios, massage therapists, personal trainers, sport medicine practitioners and other manual medicine types. Almost all of the research regarding them has come from well credentialed, peer reviewed non Chiropractors. Such is your bias that you freely criticise protocols used by many professions simply because of a poster indicating referral patterns for pain associated with trigger points in muscles appearing in a Chiropractic facility. Does that mean that you would freely criticise without basis an anatomy text just because it appears in a Chiropractic setting? This may sound ridiculous but there is little difference.
I wonder if this comment will be published as no doubt you’ll get to approve or disprove of my posting.
Hi Andrew, I didn’t say in the post ,trigger points’ were only a chiropractic thing. Nor did I say that research into ‘trigger points’ was not being done by credible researchers.
I linked to the information about ‘trigger points’ on Wikipedia and invited readers to educate themselves there, I didn’t want to put a long diversion in the post on this topic.
Note, I did not ask RMIT about trigger points. It’s not the main point of the post, I was just describing the RMIT chiropractic treatment cubicles to readers who, by and large, won’t ever have been in one.
By saying things I didn’t say you’ve mischaracterised my argument. This is better known to those interested in critical thinking as a ‘straw man argument’. I imagine, as you’ve made a comment critical of this post, that you’re on the side of chiropractic. I could say of your argument that you think ‘chiropractic works best on pink spotted elephants’, I don’t think you’d be pleased and of course, I know you didn’t say that, I’m returning your straw man.
A short video on the ‘straw man argument’ can be found here:
(http://youtu.be/kgdDK4XMpm0)
Also, did you read the comment by Dr Mick Vagg above?
I’m always interested to look at new evidence. Could you please send a link to a well conducted, rigorous clinical trial, that shows a clear link between chiropractic, knowledge of trigger points and improved health outcomes?
Although the post went up back in 2011, I’ll agree to edit the post if you can supply the evidence.
Hi Andrew,
You might like to read the Bronfort report in relation to myofascial pain syndrome.
http://chiromt.com/content/18/1/3
The Bronfort report represents an extensive search of the medical literature; commissioned by the UK’s GCC and written by chiropractors. The report says:
“Myofascial pain syndrome is a poorly defined condition that requires the presence of myofascial trigger points.”
Their conclusion in relation to myofascial pain syndrome.
“Inconclusive evidence in a favorable direction regarding the effectiveness of massage for the treatment of myofascial pain syndrome.”
The word “inconclusive” doesn’t fill me with confidence.
I am a massage therapist and have studied Trigger Point for the last eight years. I believe in what I do and tend to take a more scientific approach to what I do. I would love to answer any questions and help in anyway for anyone with questions about Trigger. I have yet to meet anyone that does true Trigger Point or Injury work the way I do. This is also a course I teach for continuing education.
Hi Vernell, thanks for making a comment.
The post is about chiropractic so you are a little off topic. However as you say you’re taking the scientific approach, I’m interested in what you have to say. Are you local to Australia? The state of Victoria?
Exactly which health conditions do you claim to effectively treat? What scientific evidence to you base your claims on? I’m particularly interested in rigorously conducted, large scale, placebo controlled, randomised, clinical trials. Such trials, if well conducted, reduce the possibility of experimenter bias. Can you provide links to peer reviewed papers published in the medical literature that support your claims?
What level of scientific evidence do you believe is warranted to support a claim to treat a particular health condition to the general public?
I was a student (in another course of study) at the Bundoora campus of RMIT Uni (it was then called Preston Institute of Technology, later Philip Inst of Tech) in the 1970s when Chiropractic was first introduced. In those days, it was not an accredited course, but rather they rented some vacant space from PIT to run their course. Slowly, over time, they ingratiated themselves into the institution and somehow managed to get themselves part of the place, and as of course, when RMIT became a university, bingo,chiropractic had managed to mainstream themselves without having to demonstrate the kind of rigour that every other health science needs to meet. Its rather shameful.
I’ve just caught an RMIT chirp grad advertising himself as ‘Doctor’ in the Solomon Islands. I will be following it up.
I don’t know about the law in the Solomon Islands, but I don’t think it’s actually illegal to call yourself “Doctor” in Australia without qualifications.