Chiropractic Care for Kids (Part 2): Believing is Seeing

Last week in clinic, a nurse took me to task for being so critical of chiropractic treatment in my blog. "I myself have become a practitioner of Reiki therapeutic touch," she said, "and I know it works wonders." She went on to explain that Reiki is a Japanese technique for stress reduction and healing. It is administered by the laying on of hands, which causes an unseen life force energy to flow from the practitioner into the patient.

"But, Susan," I protested. "What if I find scientific studies showing this doesn't work at all, except as a 'placebo'?"

"I wouldn't care," was her resolute reply. "I know it works and nothing could convince me otherwise."

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And there, in a nutshell, is the problem. There is no basis for rational debate if the issue is faith-driven and not susceptible to scientific verification.

I see her response as further evidence of a disturbing anti-science bias in this country. (For example, 51% of Americans reject the theory of evolution and 30% believe in astrology.) As the rest of the world zooms ahead in educating the scientists and engineers of the 21st century, the U.S lags behind. How long will we maintain our scientific and intellectual edge if we teach our kids to adore astrology and eschew astronomy?

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In the last post I promised to try to explain why so many love chiropractic care, despite the lack of evidence it does much of anything.

First, let's do a thought experiment. Suppose you are a chiropractor who wants to show how much help you are to your patients. How would you do that? Let's say you give them a questionnaire about their back pain at the beginning and the end of three months of treatments. The majority report improvement. They love your care! You publish your results to the acclaim of your colleagues.

But what, exactly, did your study show? Was it unbiased? No. You only used patients who came to your clinic for help, who presumably had heard good things about you and were ready to be helped. Was it objective? Not really. The fact people felt better after three months does not mean it was due to the treatment. There was no comparison group (e.g., a group that was randomly assigned to get massage therapy instead). And your patients love you, so they want to report positive gains and are reluctant to report failures. All you have shown is that your patients are generally pleased, but not that your treatment works any better than another treatment might have.

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OK, I hear the collective yawns out there, but please bear with me. In my view, this is critically important because, as best you can, you need to become more critical and sophisticated in judging the value of the latest scientific studies.

If research is to prove that a treatment is effective, it must be of the highest scientific quality or else it is hopelessly biased and misleading and unreliable. That means it should meet the 'gold standard' of scientific evidence in this area: called the randomized controlled trial (RCT).

The key elements of a RCT include: an unbiased sample selected with a specific problem, the participants are randomly assigned to more than one kind of treatment (e.g., chiropractic versus massage), objective valid outcome measures are used which are gathered by "blinded" observers (e.g., they don't know if the participant got massage or spinal manipulation).

The RCT is pretty much the standard by which all of medicine now evaluates its merit and answers the question: are we are really helping our patients or just providing snake oil? As my grandmother used to say (in another language): you have to be willing to "put your rear end on the table."

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"Evidence -based" care has become a mandate and there are now lots of smart people doing this analysis. Perhaps the foremost is the Cochrane Collaboration which critically reviews the published research and evaluates the quality of the scientific evidence for various medical issues. They put spinal manipulation for low back pain to the test of valid RCTs. Here is what they found:

"This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school, or the care given by a general practitioner. There was little or no difference in pain reduction or the ability to perform everyday activities between people with low back pain who received spinal manipulation and those who received other advocated therapies."

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So, again, you quite reasonably ask: if chiropractic care doesn't help back pain any more than a good massage, why do so many love it? Here's my take:

• Many problems (especially back pain) resolve on their own, regardless of treatment.



• People tend to seek help when the symptoms are at their worst, so odds are they will improve over time regardless, due to the normal waxing and waning of symptoms.



• Chiropractors spend more time with patients and that supportive, therapeutic relationship, plus the comforting laying on of hands, contributes to the "placebo" effect. If we are encouraged and optimistic, we feel better (maybe by altering our brain's neurochemistry). The "placebo" effect is quite powerful in many aspects of medical treatment.

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I wish I could tell you that traditional medicine was perfect, that all of our care is scientific and evidence-based. It is not and, anyway, sometimes a lack of evidence just means the appropriate studies have not yet been done. We by no means have all the answers, but at least we're trying. When the evidence leads in a direction, we try to follow it, even if it disrupts long cherished notions of what works.

The beauty of the scientifically validated medicine is that we can always be proven wrong. If we are shown to have been in error, we self-correct, and therefore our care is constantly progressing.

The shame of much so-called complementary medicine is that it can never be proven wrong. So it remains stuck in its own unfounded theories and practices, never to progress, but nonetheless absolutely certain of its own correctness.

To which perspective do you want to entrust your child's health and well-being?

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Related Topics:

• WebMD Video: How Do Placebos Work?
• Clinical Trials on Alternative Medicine

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