Tuesday, June 9, 2009

Chiropractors take money for trying to relieve asthma, despite a lack of evidence. What a wheeze!

Previous blogposts on this site have demonstrated how a collation of published research, gathered by the independent body, The Cochrane Collaboration, has shown that there is no evidence that chiropractic can relieve menstrual pains or is any better than placebo or control at relieving carpal tunnel syndrome.

Another common claim by chiropractors is that chiropractic can relieve asthma. Asthma is a complex chronic clinical condition - airway inflammation contributes to airway hyperresponsiveness, airflow limitation,
respiratory symptoms, and disease chronicity. (National Heart, Lung and Blood Institute .pdf here)

There is no cure for asthma, but there are a number of treatments that can normally manage the condition. Treatment is based on two important goals:

* Relief of symptoms.
* Preventing future symptoms from developing.

Successful prevention can be achieved through a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers.
Taken from the NHS website. As with carpal tunnel syndrome and menstrual pain, asthma is a condition which can be difficult to treat, can cause pain and inconvenience and is reasonably common - the NHS website suggests about 5 million people suffer from it in the UK. These is a classic situation for complementary and alternative medicine to step in and offer relief. The barrier to success is laid so low, as the patient is ready to try anything (regardless of evidence or how 'creative' the therapy is) just to get some respite from the condition.

As with carpal tunnel syndrome and menstrual pain, the Cochrane Collaboration has published a review on the evidence available for asthma relief by chiropractic and can be found here. (The abstract and conclusions can be found here).

The Cochrane research published in 2005 came to the following conclusion:
There is insufficient evidence to support the use of manual therapies for patients with asthma. There is a need to conduct adequately-sized RCTs that examine the effects of manual therapies on clinically relevant outcomes. Future trials should maintain observer blinding for outcome assessments, and report on the costs of care and adverse events. Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma
The hesitance in the last line is due to poorly-run trial using massage therapy that indicated some benefit, however that is outwith of chiropractic. The author notes that the best run trial between chiropractic and sham treatment found no significant difference.

Any chiropractor who keeps up to date with the research (as is required by General Chiropractic Council’s Code of Practice and Standard of Proficiency - .pdf here) would surely not advertise that chiropractic can help with asthma, or if they had been advertising it, would remove such a claim from their site. A quick search of Google shows that plenty of Chiropractors are seemingly happy to advertise asthma relief despite lack of evidence to back up the claims and therefore contravening their Code of Practice. (I mean, no-one would advertise asthma relief *knowing* that there was no evidence, right?)

As with the previous two ailments, Glasgow Chiropractic is forthright in its misguided belief of asthma help:
The chiropractor will make a detailed examination of the spine, which may include x-ray. He will then decide which misalignment of the spine requires manipulation in order to correct the problem. Correcting the misalignment can halt the chain of events which lead to closing of the airways and asthma attacks, resulting in symptomatic relief and a reduction in frequency of attacks
Fulham Wellness Chiropractic Clinic has decided that:
Chiropractic care can help improve the patient's neurological status and respiratory function through stress management, lifestyle and dietary advise together with specific joint adjustments and exercises.
I wonder how much is down to the chiropractic - the evidence suggests not a jot.
Chiropractors Brighton think:
Chiropractic care can help children with asthma
Chiropractic Health Centres, based in London reckon:
Most common symptoms helped by Chiropractic are asthma, colic and repetitive ear infections.
Many other chiropractic practices like Emerson's Green Chiropractic near Bristol also claim asthma as a treatable condition.

How can the GCC claim to be regulating chiropractic when the treatments offered for specific ailments are not backed up by any worthwhile evidence?

As discussed prevously, the Cochrane Collaboration has reviewed the available research on menstrual research and carpal tunnel syndrome and found the evidence lacking compared with placebo or control. In many cases, Chiropractic practices are claiming to be able to treat these conditions despite a complete lack of evidence. This post has demonstrated that asthma can be added to that list.

Three strikes and you're out.


BPSDB

18 comments:

  1. You sir are a bitter man. I feel sorry for you and your crusade. You clearly have no understanding of the meaning and use of the word significant. While this DOES indicate that there is a lack of consistency w/the results rendered, it DOES NOT indicate that chiro care rendered NO results, ie. subjective reporting sir. Unfortunately your raling only belittles your position and does little to solidify your point. I would submit to you that for those that have benefitted from chiro care, the results were not only significant but 100% for them. Ironically, these stories have been around for years, which is why chiro care still remains as popular as ever and will remain so much to your chagrin. I'm certain that you lack the wherewithall to actually go experience chiro care for yourself, but I'll dare you nonetheless and will revisit your so-called blog to see if actually have the fortitude to do so. My guess is that you will be the next ManCow on the matter of waterboarding and fortunately w/much LESS fanfare.

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  2. It doesn't take long for people, when faced with facts that disrupt thier worldview, to turn to personal slurs and attacks rather than deal with the evidence.

    I'll remind you what Cochrane said:
    There is insufficient evidence to support the use of manual therapies for patients with asthma.

    Whether I go for chiropractic or not is not going to change that.

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  3. You can site 1,000 studies but until you step into a Chiropractors office and witness the results yourself don't talk. Your research is very poor. you claim to make statements just by reading one paper and not following the source of your article and its clear you have not read many articles with many sources. If you want to remain closed minded then do so, but dont encourage others to do the same. Its people like you who choose to read than rather experience it for yourself. There are thousands of patients who would disagree with you. But do you site them? I think not. The truth is out there and no matter how much is written or said patients will always tell the truth and chiropractic will remain.

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  4. Hi Nate,

    You said
    "You can site 1,000 studies but until you step into a Chiropractors office and witness the results yourself don't talk."

    I'll repeat the comment above:
    "There is insufficient evidence to support the use of manual therapies for patients with asthma.

    Whether I go for chiropractic or not is not going to change that."


    I think you may not understand what a cochrane review is - it is much, much more than 'just one paper' - it is the summation of the all the suitable literature tha exists in the known universe and according to strict principals, evaluates the data.

    There my be millions of people who disagree with me - that neither makes them right nor me wrong. All the can speak is the evidence, and that says the evidence for chiropractic is extremely weak, in fact non-existant.

    T

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  5. Please Read the Info Below:

    Recent articles in publications such as "The American Chiropractor", and "Today’s Chiropractic" describe strong links between people who suffer from these conditions and nerve interference from subluxation. Subluxations are when bones in the spine pressure or irritate nerves causing abnormal nerve function. An article appearing in the Journal of Vertebral Subluxation Research Vol. 1 No. 4, also demonstrated the positive effects of chiropractic care on 81 children with asthma.

    According to Richard Pistolese, research assistant for the International Chiropractic Pediatric Association, "Based upon information currently available, chiropractic care represents a safe non-pharmacological health care approach, that may be associated with a decrease in asthma-related impairment, reduced respiratory effort, and a decrease incidence of asthma attacks." Pistolese goes further to say, "The correction of vertebral subluxation is a non-invasive procedure, which could reduce or eliminate the need for medication, and potentially ease the severity of the asthmatic condition."

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  6. Hello Sir, I think you did'nt experience Chiropractic care. I'm a woman and suffering for many years in menstrual problems.... I taking pills and pain reliever and many other treatment for pain but it doesnt help. But when I went to Chiropractic clinic and experience the treatment for the first time the pain goes away and it never bother me anymore. For me it is enough evidence that Chiropractic is a real healthcare provider...

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  7. if you are so strong quoting randomized controlled trials about efficacy of chiropractic being insufficient, why would hundreds of chiropractors be advertising the results that they are actually seeing in their office? maybe because chiropractors are consistently seeing asthmatics breathe better or because they're liars?
    maybe you should think for yourself and decide which one of those options makes the most sense. Especially since many of these claims are expressed by the patients themselves, not just the doctors

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  8. Hello nickname,

    I'm afraid you have offered a logical fallacy called "False dichotomoy". This is where an 'either/or' is offered, suggesting that these are the only two options available.

    You said

    "maybe because chiropractors are consistently seeing asthmatics breathe better or because they're liars?"

    Actually, chiropractors may well be seeing various improvements after their treatment - this is the very first step of the scientific method - observation. The next step is to investigate why it might be happening, compensate for biases, analyse behaviour, introduce blinding etc, in order to try and establish what the cause of the initial observation is.

    CHiropractors appear to have stopped at the initial observation, as the vast majority of further research suggests that it is no better than placebo or similar treatment. All the nonsense about innate knowledge getting blocked etc is just the fluff surrounding the handwaving to reason away all the 'awkward' research results that is not favourable.

    You can imagine a (silly but hey) anecdote, where a number of people come to a quack with a similar problem. Outside the quack's office is a man giving away free apples. The quack treats them with pixie dust for their issues and they all get better.

    The quack reckons he has an amazing new treatment - and from his point of view, he has. His mistake is not to question what happened and perhaps find out the the patients had actually been treated by the chappie giving away apples.

    Inane anecdote, I agree, but you can see the parallels, no doubt.

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  9. Asthma is somewhat tricky to diagnose and treat. I always had chronic respiratory infections and seemingly random airway irritation since I was a kid. I had spirometics tests done and they found no observable asthma link, but its due to the fact that I have cough variant asthma as well it being strongly controlled when not sick. Moreover when I do have asthma attacks I very rarely suffer from wheezing, moreso from constriction. Whenever I see doctors about asthma during a flu - which causes extreme tightness - they state I'm not wheezing so my lungs are fine. However wheezing is only one symptom.

    The method of asthma observation can be very murky, I've been a victim of it. It's clear that if the methods of observation are less than perfect than I wouldn't take too much creedence in any method beyond bronchilodiolators and corticosteroids (with obvious health effects) and simply monitor any extra treatments by evaluating my own quality of life in terms of breathing.

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  10. In short, I feel sorry for you. To live under the umbrella of the scientific method to determine what is right and wrong must be a restricting existence. To never experience life for yourself, and instead let a group of studies done by someone in a lab a million miles away dictate what you think must feel repressive. Do you truly believe that those individuals suffering from asthma are suffering because a lack of some drug in their system? Is the cause of their disease a lack of the chemicals from the inhalers in their bodies? I would encourage you to explore the world beyond the scope of the scientific method. Step out! You may find out something exciting, new, and educational. Try googling chiropractic and the 1918 flu epidemic. Although I don't see the words hypothesis, observation, experimentation, results, conclusion, I think you may find it interesting. I will pray for you that you explore the world outside the glass box of the scientific method and research studies. The air is fresh and the sun is bright my friend!

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  11. It's obvious that it can't CURE asthma - not even drugs can do that. what it can do (as has been demonstrated on myself!) is correct bad posture which can in turn irritate the lungs and encourage short, shallow breaths.

    it's never doing to fix the condition, but it can certainly help - alongside drugs - in the maintenance.

    having been extremely sceptical, i was bloody impressed at my improved lung capacity once i'd been "straightened out"!!

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  12. Did you read the blogpost?

    It doesn;t say anything about curing - it just says about'helping' or 'alleviating' and the evidence for chiropractic is minimal/non-existant.

    For your own personal anecdote, how do you know the chiropractic had any effect if you were doing other things alongside?

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  13. http://www.chiro.org/research/ABSTRACTS/Asthma.shtml

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  14. http://www.nejm.org/doi/full/10.1056/NEJM199810083391501

    The New England Journal of Medicine 1998 published a  study of 91 children with continuing  symptoms of asthma.  They were 
    separated into two groups, one 
    treated  with high velocity
    chiropractic adjustments and the 
    other  treated  with low  velocity 
    chiropractic adjustments. The findings were (1) 
    A small increase  in peak  expiratory flow.
    (2) Symptoms and  the  use  of b­agonists were decreased. 
    (3) No significant difference between groups.
    (4) Conclusion: No benefit.

    In the following issue, however, there was a rebuttal where  the  writer  states you  cannot use  a low force treatment as a placebo.
    “Chiropractic  manipulative  therapy is defined  as a  form of specific manual treatment used  to influence joint and  neurophysiologic function, and  it may be accomplished with a variety of techniques.” 

    In  the same follow-­up issue three other doctors point out that the study “found both forms of treatment resulted in improvement 
    in symptoms, decreased  use  of medication, and improvement in quality of life.” 

    [I find it interesting  that reduced meds and improved quality  of life did not strike those
    performing the study as "Conclusion: Benefit."] This is coming from The New England Journal of Medicine.

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  15. "In the same follow-­up issue three other doctors point out that the study “found both forms of treatment resulted in improvement
    in symptoms, decreased use of medication, and improvement in quality of life.”


    Nice quotemining.

    The next sentence is:

    "However, these changes did not differ significantly between the active-treatment and simulated-treatment groups."

    Did you not agree with that line, so omitted it, or did it not sit happily with what you believe?

    T

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  16. i googled and just under your result was this http://www.ncbi.nlm.nih.gov/pubmed/20195423

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  17. Results of the eight retrieved studies indicated that chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant.

    ReplyDelete

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