Chiropractic Regulations Worldwide
April 2, 2010 5:14 AM Subscribe
In Australia, to be a chiropractic you need to study formal chiropractic degrees (Bachelors and Masters at least) and do years of pracs that are pretty similar to other medical courses. Chiropractic is also recognised as a Skilled Profession under Australian immigration, and are generally considered amongst the same league as physiotherapy and other musculo-skeletal therapists. However, in the US and the UK, chiropractics are often considered quacks and charlatans. Why the huge discrepancies?
I would highly doubt that the Australian Government would recognise anything that's quackers - they're pretty stringent on what gets counted as skilled. Also, it seems that Australian practitioners have more in-depth education than those elsewhere - otherwise why would otherwise reputable universities offer such a course?
How are chiropractics elsewhere trained and certified? What qualifies you as a professional proper certified chiropractic around the world? Why is it vastly different in Australia?
(the same applies to naturopathy and acupuncture too - recognised & regulated in Australia, target of scorn elsewhere. Was there some sort of significant complementary medicine movement in Australian history?)
I would highly doubt that the Australian Government would recognise anything that's quackers - they're pretty stringent on what gets counted as skilled. Also, it seems that Australian practitioners have more in-depth education than those elsewhere - otherwise why would otherwise reputable universities offer such a course?
How are chiropractics elsewhere trained and certified? What qualifies you as a professional proper certified chiropractic around the world? Why is it vastly different in Australia?
(the same applies to naturopathy and acupuncture too - recognised & regulated in Australia, target of scorn elsewhere. Was there some sort of significant complementary medicine movement in Australian history?)
As for acupuncture: Eastern medicine has never received widespread trust in the US.
posted by amro at 5:27 AM on April 2, 2010
posted by amro at 5:27 AM on April 2, 2010
Response by poster: I did read the Wikipedia article, but it didn't seem to articulate why it's different in different countries (or perhaps we missed that).
posted by divabat at 5:33 AM on April 2, 2010
posted by divabat at 5:33 AM on April 2, 2010
I'm not sure if you mean why the level of respect is different, or why the regulations are different, but this article may be more helpful to you.
posted by amro at 5:37 AM on April 2, 2010
posted by amro at 5:37 AM on April 2, 2010
Taking one part of your question: just because acupuncture undergoes government regulation in Australia doesn't mean it is being recognised by the state as an effective therapy. I think the regulations are there in part to ensure a baseline level of safety (such as clean, single-use needles) and to provide a channel for pursuing misconduct by acupuncturists. I would also suggest that traditional Chinese medicine has a higher profile in Australia in part because of the strong presence there of the Chinese diaspora (as compared with, say, the UK).
As for chiropractic, again, simply because it is recognised as a skilled profession for immigration purposes doesn't mean it is getting the government tick of approval as an effective therapy. It simply means it is recognised as being an area of the economy where there is currently a demand for skilled workers; same for hairdressing. Yes, there are formal degrees for chiropractic, as there are in the US and UK. I'm not sure that it's "vastly different" at all (indeed, as far as I know, Australia does not go as far as allowing its chiropracters to call themselves doctor, as the US does). I'd suggest that chiropractic has at least the same or high level of public acceptance in the US as in Australia.
In general, I'd suggest that Federal and State Governments in Australia have been less, rather than more, likely to embrace "quacks and charlatans" or put public money into alt med. We have not made homeopathy available Medicare (as per UK), and we have not established a multi-million dollar public research facility designed essentially to fund trials to validate alt med therapies (as per NCCAM in the US).
posted by dontjumplarry at 5:59 AM on April 2, 2010 [4 favorites]
As for chiropractic, again, simply because it is recognised as a skilled profession for immigration purposes doesn't mean it is getting the government tick of approval as an effective therapy. It simply means it is recognised as being an area of the economy where there is currently a demand for skilled workers; same for hairdressing. Yes, there are formal degrees for chiropractic, as there are in the US and UK. I'm not sure that it's "vastly different" at all (indeed, as far as I know, Australia does not go as far as allowing its chiropracters to call themselves doctor, as the US does). I'd suggest that chiropractic has at least the same or high level of public acceptance in the US as in Australia.
In general, I'd suggest that Federal and State Governments in Australia have been less, rather than more, likely to embrace "quacks and charlatans" or put public money into alt med. We have not made homeopathy available Medicare (as per UK), and we have not established a multi-million dollar public research facility designed essentially to fund trials to validate alt med therapies (as per NCCAM in the US).
posted by dontjumplarry at 5:59 AM on April 2, 2010 [4 favorites]
Chiropractic is also recognised as a Skilled Profession under Australian immigrationThe principal goal of Australian immigration policy is to stimulate economic growth, not improve public health.
posted by caek at 6:17 AM on April 2, 2010 [8 favorites]
It doesn't help thatAmerican Chiropractic Association doesn't take a hard line against quackery.
In Australia, does the licensing body specify that chiropractic can't cure AIDS or cancer and that woo woo diagnostics like the pressure-sensitive roller device used to allegedly show spinal...something...are not X-rays?
My chiro took a course of study very much like the one to which you linked, divabat, and she's American. The quacks drive her batty.
posted by desuetude at 6:17 AM on April 2, 2010 [1 favorite]
In Australia, does the licensing body specify that chiropractic can't cure AIDS or cancer and that woo woo diagnostics like the pressure-sensitive roller device used to allegedly show spinal...something...are not X-rays?
My chiro took a course of study very much like the one to which you linked, divabat, and she's American. The quacks drive her batty.
posted by desuetude at 6:17 AM on April 2, 2010 [1 favorite]
I would highly doubt that the Australian Government would recognise anything that's quackers
In fairness, until recently the UK was funding homeopathic treatments through the NHS. Governments, not just Australia's, tend to be slow to react to opinion in science-based medicine.
In my (anecdotal) experience, people who 'believe' in chiropractic fall into two camps: those who think a chiropractor can help you with a bad back, and those who believe chiropractic can help with all manner of health problems: asthma, mental health, skin conditions.
In Australia, I think most people fall into the 1st camp. Which I guess is the one that seems more credible. I certainly wasn't aware that chiropractors made bolder claims beyond spinal manipulation until I moved overseas.
Without wanting to derail, both ideas are flawed as there is little scientific evidence to support either claim. There is a growing skepticism towards alternative medicine in general, helped by perhaps spurred by events in the UK. I actually think Australia is running a pretty close third behind the UK and US in terms of skeptical activism. Check out Australian Skeptics, or their excellent podcast if you would like to know more about it.
posted by TheOtherGuy at 6:18 AM on April 2, 2010 [3 favorites]
In fairness, until recently the UK was funding homeopathic treatments through the NHS. Governments, not just Australia's, tend to be slow to react to opinion in science-based medicine.
In my (anecdotal) experience, people who 'believe' in chiropractic fall into two camps: those who think a chiropractor can help you with a bad back, and those who believe chiropractic can help with all manner of health problems: asthma, mental health, skin conditions.
In Australia, I think most people fall into the 1st camp. Which I guess is the one that seems more credible. I certainly wasn't aware that chiropractors made bolder claims beyond spinal manipulation until I moved overseas.
Without wanting to derail, both ideas are flawed as there is little scientific evidence to support either claim. There is a growing skepticism towards alternative medicine in general, helped by perhaps spurred by events in the UK. I actually think Australia is running a pretty close third behind the UK and US in terms of skeptical activism. Check out Australian Skeptics, or their excellent podcast if you would like to know more about it.
posted by TheOtherGuy at 6:18 AM on April 2, 2010 [3 favorites]
Part of the problem is that Chiropractors have a tendency to believe in other alternative medicines as well. So if you go to a chiropracter, you're more likely to hear about some other nonsense as well. But that said, the treatment for back pain does work.
You also have some real out-there Chiropractors, who think you can fix any problem by doing adjustments, or whatever. And because of that you have people who highlight the crazier ones. There should probably be more policing of the issue, and maybe there will be in the U.K. going forward.
here's a post I made a while ago that links to some of the studies that have been done. The evidence does show that Spinal Manipulation Therapy does work.
posted by delmoi at 6:36 AM on April 2, 2010
You also have some real out-there Chiropractors, who think you can fix any problem by doing adjustments, or whatever. And because of that you have people who highlight the crazier ones. There should probably be more policing of the issue, and maybe there will be in the U.K. going forward.
Without wanting to derail, both ideas are flawed as there is little scientific evidence to support either claim.Ugh, this is such nonsense. First of all, a blog is not a peer reviewed scientific publication just because it has the word "science" in the title. And secondly, the page you linked to doesn't even say that it doesn't work for back pain. Instead, the article complains about the fact that the ideas of the founder, formulated in the 1890s is incorrect. But you could say exactly the psychology and Sigmund Freud.
here's a post I made a while ago that links to some of the studies that have been done. The evidence does show that Spinal Manipulation Therapy does work.
posted by delmoi at 6:36 AM on April 2, 2010
I'm not sure I'd describe the US as a hotbed of skepticism for chiropractic; there are plenty of chiropractors here and they don't seem to be starving for business. My health insurance actually covers visits to a chiropractor, though only for back problems.
posted by strangely stunted trees at 6:40 AM on April 2, 2010
posted by strangely stunted trees at 6:40 AM on April 2, 2010
@delmoi - You obviously didn't read the article, or did you just miss the section that takes up perhaps a third of the entire article entitled 'Summary of Key Research'.
It lists about a dozen peer-reviewed scientific studies that are critical of different aspects of chiropractic. Because the act of scrolling seems to be difficult for you, let me post the abstract of the very first article it lists:
Ernst E, Carter PH. A systematic review of systematic reviews of spinal manipulation. J R Soc Med 99:192,196, 2006.
Summary: A systematic review of systematic reviews published between 2000 and 2005, based on 16 studies that met the criteria. “Overall, the demonstrable benefit of SM seems to be minimal in the case of acute or chronic back pain; controversial in the case of headache; or absent for all other indications… we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition.”
posted by TheOtherGuy at 6:56 AM on April 2, 2010
It lists about a dozen peer-reviewed scientific studies that are critical of different aspects of chiropractic. Because the act of scrolling seems to be difficult for you, let me post the abstract of the very first article it lists:
Ernst E, Carter PH. A systematic review of systematic reviews of spinal manipulation. J R Soc Med 99:192,196, 2006.
Summary: A systematic review of systematic reviews published between 2000 and 2005, based on 16 studies that met the criteria. “Overall, the demonstrable benefit of SM seems to be minimal in the case of acute or chronic back pain; controversial in the case of headache; or absent for all other indications… we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition.”
posted by TheOtherGuy at 6:56 AM on April 2, 2010
Most government 'recognition' is just that. Recognition that a profession exists and in this case requires a certain skill level. An immigration department is not able to judge if people going to a chiropracter are served well as far as the condition they suffer from is concerned.
In the UK, regultory bodies for all types of practice professions that I know of are self regulating associations which regulate their own profession. This system which is followed by most countries is old and useless. Its foundations lie in honour and reputation of the community of practitioners and not in its ability to heal (which is taken for granted) or the rights of the patients (subjects). Even today in most cases a practitioner who molests a patient is struck off for 'bringing disrepute to the profession'. This system fails to deliver particulary when the whole profession is being investigated due to an inbuilt conflict of interest related to the livelihoods of the fee paying members.
Chiroquacks as they are popularly known here subscribe to a completely unproven belief that the point where the base of your skull meets your spine is where all illnesses originate and some form of quaqery at that point can make you better. I doubt that this belief is not central to the Australian version of chiroquacks. Making them go through so called bachelors or masters degrees says nothing about how effective the treatment is but about the earning potential it gives to people who IMHO are either unable to find an honest living or are too gullible to fall for it.
posted by london302 at 7:02 AM on April 2, 2010
In the UK, regultory bodies for all types of practice professions that I know of are self regulating associations which regulate their own profession. This system which is followed by most countries is old and useless. Its foundations lie in honour and reputation of the community of practitioners and not in its ability to heal (which is taken for granted) or the rights of the patients (subjects). Even today in most cases a practitioner who molests a patient is struck off for 'bringing disrepute to the profession'. This system fails to deliver particulary when the whole profession is being investigated due to an inbuilt conflict of interest related to the livelihoods of the fee paying members.
Chiroquacks as they are popularly known here subscribe to a completely unproven belief that the point where the base of your skull meets your spine is where all illnesses originate and some form of quaqery at that point can make you better. I doubt that this belief is not central to the Australian version of chiroquacks. Making them go through so called bachelors or masters degrees says nothing about how effective the treatment is but about the earning potential it gives to people who IMHO are either unable to find an honest living or are too gullible to fall for it.
posted by london302 at 7:02 AM on April 2, 2010
If you examine the history of chiropractic in America you discover that it was not much of a money -making profession for years till they were able to get recognized and accepted by the insurance industry, after which the multiple visits they required, now re-inbursed by insurance, made it a profession that made a nice income for those in the business. My note here in no way comments upon the field for its general usefulness.
posted by Postroad at 7:32 AM on April 2, 2010
posted by Postroad at 7:32 AM on April 2, 2010
Delmoi is again selectively quotes from the literature to support his view that chiropractic "does work." Some of the previous responses to him may be helpful, including my own, from which this is a small snippet:
Why? The decision as to which professions are skilled professions is unlikely to be made with any consideration of the medical evidence or by someone with medical qualifications. You get the same number of immigration points for being a child care center manager as you do for being a chiropractor.
posted by grouse at 7:49 AM on April 2, 2010 [4 favorites]
An accurate statement of "mainstream science" on spinal manipulative therapy cannot be reduced to a sound bite such as "chiropractic care works." Instead it would be more like this:I would highly doubt that the Australian Government would recognise anything that's quackersThere is "very low-quality evidence"1 that spinal manipulative therapy provides a treatment of "modest effectiveness"2 for chronic low back pain, when compared to placebo. There is no evidence2 that spinal manipulative therapy provides superior treatment to other advocated treatment methods.A bit less snappy than "it works" but much more accurate.
Why? The decision as to which professions are skilled professions is unlikely to be made with any consideration of the medical evidence or by someone with medical qualifications. You get the same number of immigration points for being a child care center manager as you do for being a chiropractor.
posted by grouse at 7:49 AM on April 2, 2010 [4 favorites]
other advocated treatment methods
To be fair, these "other" methods seem to be limited to a scrip for muscle relaxants, which render most people semi-conscious, and a recommendation to lose weight, if you're overweight. Unless you have a clear injury warranting surgery, there aren't really any effective mainstream treatments for chronic low back pain.
posted by desuetude at 8:09 AM on April 2, 2010
To be fair, these "other" methods seem to be limited to a scrip for muscle relaxants, which render most people semi-conscious, and a recommendation to lose weight, if you're overweight. Unless you have a clear injury warranting surgery, there aren't really any effective mainstream treatments for chronic low back pain.
posted by desuetude at 8:09 AM on April 2, 2010
I would highly doubt that the Australian Government would recognise anything that's quackers
1. Set up a coalition of practitioners.
2. Lobby government for some kind of regulation of the profession. This isn't too hard. In my state, we've got licensing boards for hair stylists and plumbers. The licensing clearly has nothing to do with science, just public safety. Oh, and the state making some money off of license fees.
3. Get your own people on the licensing board. Obviously they're the best choice sine who else knows about your profession? You see where this is going!
4. Profit.
posted by paanta at 8:12 AM on April 2, 2010
1. Set up a coalition of practitioners.
2. Lobby government for some kind of regulation of the profession. This isn't too hard. In my state, we've got licensing boards for hair stylists and plumbers. The licensing clearly has nothing to do with science, just public safety. Oh, and the state making some money off of license fees.
3. Get your own people on the licensing board. Obviously they're the best choice sine who else knows about your profession? You see where this is going!
4. Profit.
posted by paanta at 8:12 AM on April 2, 2010
For years, doctors waged war against chiropractors. From this chiropractic site:
" . . . AMA and the medical community as a whole had been trying to create misunderstanding in people’s minds about chiropractic and other alternative healthcare systems. . . .
. . . . the AMA was working steadily to harm the reputation of chiropractic as a system. Doctors were asked not to refer their patients to chiropractic. AMA actively spread the message that chiropractic was unscientific and that chiropractors were quacks. Chiropractors could not work in hospitals or avail diagnostic facilities of hospitals for their patients. It was also clearly proved that the AMA had not done this in genuine public interest, but with an intention to hurt competition.
After 14 years of legal war, a ruling made by the US Supreme Court on 7 February 1990 came as a well deserved victory to chiropractors in the country. The ruling stated that the court found the AMA guilty of illegal propaganda against chiropractic. AMA was ordered to stop its attack of the chiropractic system. The court also ordered AMA to publish its order in AMA’s publications."
posted by feelinggood at 8:15 AM on April 2, 2010
" . . . AMA and the medical community as a whole had been trying to create misunderstanding in people’s minds about chiropractic and other alternative healthcare systems. . . .
. . . . the AMA was working steadily to harm the reputation of chiropractic as a system. Doctors were asked not to refer their patients to chiropractic. AMA actively spread the message that chiropractic was unscientific and that chiropractors were quacks. Chiropractors could not work in hospitals or avail diagnostic facilities of hospitals for their patients. It was also clearly proved that the AMA had not done this in genuine public interest, but with an intention to hurt competition.
After 14 years of legal war, a ruling made by the US Supreme Court on 7 February 1990 came as a well deserved victory to chiropractors in the country. The ruling stated that the court found the AMA guilty of illegal propaganda against chiropractic. AMA was ordered to stop its attack of the chiropractic system. The court also ordered AMA to publish its order in AMA’s publications."
posted by feelinggood at 8:15 AM on April 2, 2010
To be fair, these "other" methods seem to be limited to a scrip for muscle relaxants, which render most people semi-conscious, and a recommendation to lose weight, if you're overweight.
That is not actually fair; the other methods include NSAIDs (moderate-quality evidence) or back exercise (very low-quality evidence).
Unless you have a clear injury warranting surgery, there aren't really any effective mainstream treatments for chronic low back pain.
This I would probably agree with.
After 14 years of legal war, a ruling made by the US Supreme Court on 7 February 1990 came as a well deserved victory to chiropractors in the country.
Like so many things on chiropractic web sites, this is an utter falsehood. There was a ruling of the Seventh Circuit Court of Appeals on that day. The Supreme Court never ruled on the merits of the case.
posted by grouse at 8:37 AM on April 2, 2010
That is not actually fair; the other methods include NSAIDs (moderate-quality evidence) or back exercise (very low-quality evidence).
Unless you have a clear injury warranting surgery, there aren't really any effective mainstream treatments for chronic low back pain.
This I would probably agree with.
After 14 years of legal war, a ruling made by the US Supreme Court on 7 February 1990 came as a well deserved victory to chiropractors in the country.
Like so many things on chiropractic web sites, this is an utter falsehood. There was a ruling of the Seventh Circuit Court of Appeals on that day. The Supreme Court never ruled on the merits of the case.
posted by grouse at 8:37 AM on April 2, 2010
Feelinggood, did the ruling say anywhere that chiropractic works? I thought not...
You can get a judgement against persecution of fire worshippers but that says nothing about fire worshipping being good or useful or effective.
posted by london302 at 8:40 AM on April 2, 2010
You can get a judgement against persecution of fire worshippers but that says nothing about fire worshipping being good or useful or effective.
posted by london302 at 8:40 AM on April 2, 2010
Thanks grouse for clarification about the judgement. Such deliberate mischaracterisation does call into question the quality of comments it accompanies.
posted by london302 at 8:45 AM on April 2, 2010
posted by london302 at 8:45 AM on April 2, 2010
For what it's worth: purely anecdotally, I've found chiropractic isn't treated with much skepticism over here in the US. Many insurance programs cover it.
posted by koeselitz at 9:17 AM on April 2, 2010
posted by koeselitz at 9:17 AM on April 2, 2010
It was also clearly proved that the AMA had not done this in genuine public interest, but with an intention to hurt competition.
Don't spread misinformation about the Wilk case based on a link to a web-page in comic sans.
The case did NOT go to the Supreme Court. The Court denied certiorari in that case. It was decided district court and the decision was upheld in the US Court of Appeals in 1990. Wikipedia is your friend. The relevant snippets from Judge Getzendanner's decision are as follows:
"The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study... No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence."
"While there is some evidence that the Committee on Quackery and the AMA were motivated by economic concerns – there are too many references in the record to chiropractors as competitors to ignore – I am persuaded that the dominant factor was patient care and the AMA's subjective belief that chiropractic was not in the best interests of patients."
The fundamental problem with chiropractic is that regardless of whether it helps or not for back pain (and it may, to a modest degree based on the literature), Palmer's classic mechanistic explanations purported by chiropractors regarding "subluxation" are utter nonsense. It remains in complete conflict with a very vast body of knowledge we have developed about human anatomy. To accept the theory of subluxation (which is also steeped in metaphysics) is to reject all of what we know about the mechanical properties of spinal bones and their attachments. This, in addition to specious claims regarding its therapeutic effects on anything other than back pain, and the conduct of tests/procedures that are either unvalidated or for which they are unqualified to evaluate (ie x-ray imaging) will always haunt chiropractic.
To get back to divabat's question, how much of an affect the AMA's machinations had on the U.S. public's acceptance of chiropractic is unclear, though I'd assume it did have some impact. I would submit however that you've made a false assumption about governments validating the efficacy of chiropractic as a result of recognizing the practice. Also, the U.S. and Australian governments' treatment of chiropractic are more alike than different. In the U.S., the Council on Chiropractic Education is formally recognized by the U.S. Secretary of Education for accreditation of institutions providing chiropractic education/training.
posted by drpynchon at 9:18 AM on April 2, 2010 [7 favorites]
Don't spread misinformation about the Wilk case based on a link to a web-page in comic sans.
The case did NOT go to the Supreme Court. The Court denied certiorari in that case. It was decided district court and the decision was upheld in the US Court of Appeals in 1990. Wikipedia is your friend. The relevant snippets from Judge Getzendanner's decision are as follows:
"The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study... No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence."
"While there is some evidence that the Committee on Quackery and the AMA were motivated by economic concerns – there are too many references in the record to chiropractors as competitors to ignore – I am persuaded that the dominant factor was patient care and the AMA's subjective belief that chiropractic was not in the best interests of patients."
The fundamental problem with chiropractic is that regardless of whether it helps or not for back pain (and it may, to a modest degree based on the literature), Palmer's classic mechanistic explanations purported by chiropractors regarding "subluxation" are utter nonsense. It remains in complete conflict with a very vast body of knowledge we have developed about human anatomy. To accept the theory of subluxation (which is also steeped in metaphysics) is to reject all of what we know about the mechanical properties of spinal bones and their attachments. This, in addition to specious claims regarding its therapeutic effects on anything other than back pain, and the conduct of tests/procedures that are either unvalidated or for which they are unqualified to evaluate (ie x-ray imaging) will always haunt chiropractic.
To get back to divabat's question, how much of an affect the AMA's machinations had on the U.S. public's acceptance of chiropractic is unclear, though I'd assume it did have some impact. I would submit however that you've made a false assumption about governments validating the efficacy of chiropractic as a result of recognizing the practice. Also, the U.S. and Australian governments' treatment of chiropractic are more alike than different. In the U.S., the Council on Chiropractic Education is formally recognized by the U.S. Secretary of Education for accreditation of institutions providing chiropractic education/training.
posted by drpynchon at 9:18 AM on April 2, 2010 [7 favorites]
There are a signficiant number of UK degrees available from (otherwise) reputable universities in the UK. Singh and Ernst cite Colquhoun as having found 61 degrees relating to alternative medicine across 16 UK universities in 2007. Essentially the universities are in it for the money, happy to develop product to meet demand rather than make a commitment to teaching from scientific principles. Is the same true of Australian insitutions?
As a UK academic myself I have to admit to previously wondering what the process is within these institutions whereby modules and courses get approved.
posted by biffa at 9:49 AM on April 2, 2010
As a UK academic myself I have to admit to previously wondering what the process is within these institutions whereby modules and courses get approved.
posted by biffa at 9:49 AM on April 2, 2010
What you have to look at is how well it is institutionalized, the differences in how it is viewed, and the ability for someone to bring into question that institution.
For what it's worth: purely anecdotally, I've found chiropractic isn't treated with much skepticism over here in the US. Many insurance programs cover it.
Actually it is and Chiropractic is an axe scientific skeptics love to grind. I was listening to a podcast from The Skeptic's Guide to the Universe recently and they were talking about the differences in the scientific skepticism movement around the world. They mentioned that not only is it specifically a western movement but more or less a US movement. I'm not sure about Australia, but by looking at the case of Simon Singh in the UK, it would seem to me as an American that he made reasonable statements and I doubt it would cause much of an uproar from chiropractors here. Although i think there is a huge disparity between "it cures colic" and "it decreases back pain", and I think a lot of people don't make those distinctions when deciding on the quackeryness of chiropractic. Personally, I've seen and been to good and bad chiropractors, and my idea of how that spectrum is defined would be by the amount of quackery the chiro rests upon to sell his skills. The heaviness of woo woo leaning into the bad side of course.
How are chiropractics elsewhere trained and certified? What qualifies you as a professional proper certified chiropractic around the world? Why is it vastly different in Australia
I didn't read all 51 pages of this PDF from the World Health Organization, but this wiki outlines the education required. From what I gather it takes about six to eight years in North America.
posted by P.o.B. at 9:54 AM on April 2, 2010
For what it's worth: purely anecdotally, I've found chiropractic isn't treated with much skepticism over here in the US. Many insurance programs cover it.
Actually it is and Chiropractic is an axe scientific skeptics love to grind. I was listening to a podcast from The Skeptic's Guide to the Universe recently and they were talking about the differences in the scientific skepticism movement around the world. They mentioned that not only is it specifically a western movement but more or less a US movement. I'm not sure about Australia, but by looking at the case of Simon Singh in the UK, it would seem to me as an American that he made reasonable statements and I doubt it would cause much of an uproar from chiropractors here. Although i think there is a huge disparity between "it cures colic" and "it decreases back pain", and I think a lot of people don't make those distinctions when deciding on the quackeryness of chiropractic. Personally, I've seen and been to good and bad chiropractors, and my idea of how that spectrum is defined would be by the amount of quackery the chiro rests upon to sell his skills. The heaviness of woo woo leaning into the bad side of course.
How are chiropractics elsewhere trained and certified? What qualifies you as a professional proper certified chiropractic around the world? Why is it vastly different in Australia
I didn't read all 51 pages of this PDF from the World Health Organization, but this wiki outlines the education required. From what I gather it takes about six to eight years in North America.
posted by P.o.B. at 9:54 AM on April 2, 2010
@delmoi - You obviously didn't read the article, or did you just miss the section that takes up perhaps a third of the entire article entitled 'Summary of Key Research'.
First of all, the thread is about the perception of Chiropractic care in the U.S and UK. But anyway, so this is kind of a derail. But here is a quote from from your link:
In other words, more effective then placebo, as effective as other techniques. Which is exactly what I said. Which isn't very surprising, since I was correct. And we're still talking about a blog post here. There are hundreds of studies on this topic; the ones that I linked too in my other comment were broad metastudies on back pain.
Now, let's review the comment I was initially replying to:
---
I've got no problem criticizing chiropractors for making claims that science can't support. But this insistence that it doesn't work, contrary to the actual evidence is incorrect and kind of strange.
Back to the original question:
posted by delmoi at 10:00 AM on April 2, 2010
First of all, the thread is about the perception of Chiropractic care in the U.S and UK. But anyway, so this is kind of a derail. But here is a quote from from your link:
A systematic review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham therapy and therapies already known to be unhelpful. It was no more or less effective than medication for pain, physical therapy, exercises, back school, or the care given by a general practitioner.
In other words, more effective then placebo, as effective as other techniques. Which is exactly what I said. Which isn't very surprising, since I was correct. And we're still talking about a blog post here. There are hundreds of studies on this topic; the ones that I linked too in my other comment were broad metastudies on back pain.
Delmoi is again selectively quotes from the literature to support his view that chiropractic "does work." Some of the previous responses to him may be helpful, including my own, from which this is a small snippet:Right, there is no evidence that it's superior, and no evidence that it's worse either. People who argue that Chiropractic care doesn't work make the first part of the claim, and leave off the second, implying by omission that it doesn't work.
Now, let's review the comment I was initially replying to:
Without wanting to derail, both ideas are flawed as there is little scientific evidence to support either claim. -- TheOtherGuyHe said the idea was "flawed" and that there was little evidence to support the claim. Those were both incorrect, which even your comment points out.
---
I've got no problem criticizing chiropractors for making claims that science can't support. But this insistence that it doesn't work, contrary to the actual evidence is incorrect and kind of strange.
Back to the original question:
However, in the US and the UK, chiropractics are often considered quacks and charlatans. Why the huge discrepancies?Well, this trial in the U.K probably didn't do much for their reputation there. But I wonder how much of your perception that Chiropractors are thought of as quacks in the U.S. comes from internet comments? I don't know that many people even know that much about the issue over all. When I went to a regular doctor for back pain in high school, he suggested going to a Chiropractor, and it worked. So it's not all that clear how representative of a sample you're seeing here.
posted by delmoi at 10:00 AM on April 2, 2010
But this insistence that it doesn't work, contrary to the actual evidence is incorrect and kind of strange.
What? Quoting Ernst from Journal of Pain and Symptom Management Volume 35, Issue 5, May 2008, Pages 544-562:
"In 2001, a systematic review of five prospective studies concluded that mild-to-moderate, transient adverse effects are experienced by about half of all chiropractic patients.[165] Local or radiating pain, headache, and tiredness are the most frequent adverse effects. Since then, two further prospective studies (n = 465 and 336, respectively) reported that such adverse effects occur in 61% and 30% of patients. [166,167] Therefore, there is undeniable evidence that chiropractic is associated with an exorbitantly high incidence of minor adverse effects. Spinal manipulation of the upper spine has frequently been associated with serious vascular accidents. A systematic review summarized the data up to November 2001,[168] and an update reviewed the latest evidence.[169] In total, this disclosed around 700 serious complications and about 50 deaths. Five surveys have been published asking doctors to report instances where their patients have experienced serious adverse effects after spinal manipulation. [170-174] The results invariably disclosed a multitude of complications after chiropractic manipulation. More importantly, they demonstrated that these instances had not previously been reported in the medical literature. In other words, underreporting had been 100%. Therefore, it seems highly doubtful whether reliable incidence figures can presently be calculated. A recent systematic review found 14 cases of adverse effects of spinal manipulation in children, 10 of which involved serious complications such as subarachnoidal hemorrhage or paraplegia.[175]"
You might personally like chiropractic treatments, but the published evidence shows that it is undeniably associated with harm not benefit.
posted by roofus at 5:53 PM on April 2, 2010
What? Quoting Ernst from Journal of Pain and Symptom Management Volume 35, Issue 5, May 2008, Pages 544-562:
"In 2001, a systematic review of five prospective studies concluded that mild-to-moderate, transient adverse effects are experienced by about half of all chiropractic patients.[165] Local or radiating pain, headache, and tiredness are the most frequent adverse effects. Since then, two further prospective studies (n = 465 and 336, respectively) reported that such adverse effects occur in 61% and 30% of patients. [166,167] Therefore, there is undeniable evidence that chiropractic is associated with an exorbitantly high incidence of minor adverse effects. Spinal manipulation of the upper spine has frequently been associated with serious vascular accidents. A systematic review summarized the data up to November 2001,[168] and an update reviewed the latest evidence.[169] In total, this disclosed around 700 serious complications and about 50 deaths. Five surveys have been published asking doctors to report instances where their patients have experienced serious adverse effects after spinal manipulation. [170-174] The results invariably disclosed a multitude of complications after chiropractic manipulation. More importantly, they demonstrated that these instances had not previously been reported in the medical literature. In other words, underreporting had been 100%. Therefore, it seems highly doubtful whether reliable incidence figures can presently be calculated. A recent systematic review found 14 cases of adverse effects of spinal manipulation in children, 10 of which involved serious complications such as subarachnoidal hemorrhage or paraplegia.[175]"
You might personally like chiropractic treatments, but the published evidence shows that it is undeniably associated with harm not benefit.
posted by roofus at 5:53 PM on April 2, 2010
Why the huge discrepancies?
Physiotherapists in Australia were once lumped in with massage therapists. They got professionally organised and lobbied for laws restricting access to the profession. Once they did that they gradually raised the barrier to entry by requiring higher levels of formal education. I presume that chiropractors did the same - it's a great way to increase the prestige of your field while simultaneously reducing competition.
posted by Joe in Australia at 8:24 AM on April 3, 2010
Physiotherapists in Australia were once lumped in with massage therapists. They got professionally organised and lobbied for laws restricting access to the profession. Once they did that they gradually raised the barrier to entry by requiring higher levels of formal education. I presume that chiropractors did the same - it's a great way to increase the prestige of your field while simultaneously reducing competition.
posted by Joe in Australia at 8:24 AM on April 3, 2010
What? Quoting Ernst from Journal of Pain and Symptom Management Volume 35, Issue 5, May 2008, Pages 544-562:I'm not quite sure what that has to do with anything I said. Other treatments also have side effects. Back surgery, obviously, is going to have side effects. Opiates for pain control can cause addiction, and so on.
You might personally like chiropractic treatments, but the published evidence shows that it is undeniably associated with harm not benefit.Well, that statement is half false. Evidence shows that it works for back pain as well as other treatments. The "minor adverse effects" thing, like headaches or tiredness is not really a big deal, and needs to be compared with other treatment options.
As for the serious complications, keep in mind that when you're talking about medicine 50 and 700 are pretty small numbers, especially when they're not annualized. Keep in mind that almost 100,000 die every year to medical error.
From the US Government's Agency for Healthcare research and quality:
The November 1999 report of the Institute of Medicine (IOM), entitled To Err Is Human: Building A Safer Health System, focused a great deal of attention on the issue of medical errors and patient safety. The report indicated that as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors.Would it be fair to say that "Medicine is associated with harm"? Of course. Would it be fair to say that "Medicine is associated with harm, and not benefit"? Of course not. But that said, simple things like checklists can cut down on medical error quite a bit, but they're often not used.
Even using the lower estimate, this would make medical errors the eighth leading cause of death in this country—higher than motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516). About 7,000 people per year are estimated to die from medication errors alone—about 16 percent more deaths than the number attributable to work-related injuries.
posted by delmoi at 1:39 PM on April 3, 2010
This thread is closed to new comments.
I would guess that perhaps the governing body for chiropractics in Australia is more stringent and has higher standards than its American equivalent, and thus chiropractors garner more trust, respect, etc. in Australia... But that's just a guess.
posted by amro at 5:24 AM on April 2, 2010