The evidence shows that chiropractors do more harm than good

In several hundred cases patients have been seriously and often permanently damaged

One of my teachers in medical school kept saying: ‘A treatment that has no side-effects is already a good one.’ These seemed to be wise words worth remembering. But today I think he may have been not entirely correct: there is no therapy that does not have potential to cause adverse effects. What really counts, in life as in medicine, is a reasonable balance between risk and benefit.

Chiropractic treatment is an excellent example of the importance of this balance. Chiropractors rely heavily on manipulating their patients’ spines, and the benefits are not at all clear. Practitioners usually insist that their manipulations are effective for a bafflingly wide range of conditions. On the internet, for instance, it is hard to find an illness that chiropractors do not claim to cure. However, the published evidence generally reveals these claims to be little more than wishful thinking. Therefore, even relatively minor side-effects might tilt the risk/benefit balance into the negative.

There is now a lot of evidence showing that more than half of all patients suffer mild to moderate adverse effects after seeing a chiropractor. These are mostly local and referred pains that usually last for two to three days. Chiropractors often claim that these are necessary steps on the road to getting better. On a good day, we might even believe them.

But unfortunately there is more, much more. Several hundred cases have been documented in which patients were seriously and often permanently damaged after chiropractic manipulations. The latest to hit the headlines was that of a 32-year-old woman from Jakarta who died after being treated by an American chiropractor. What usually happens in these tragic instances is that, upon manipulation of the upper spine, an artery supplying the brain is over-stretched and simply breaks up, leading to a stroke which can prove fatal.

Chiropractors do not like to hear any of this, and either claim that these are extremely rare events, or deny any connection with their manipulations. Regrettably, the hard evidence is not as solid as one would wish. In conventional medicine we have effective systems to monitor adverse effects of all interventions — not so in alternative medicine. Therefore, the true frequency of such tragedies is anyone’s guess. About 30 deaths after chiropractic have been documented in medical literature, but they are probably just the tip of a much bigger iceberg. We have shown, for instance, that in the UK the under-reporting of such instances is very close to 100 per cent.

All clinicians, alternative or conventional, must obtain informed consent from patients before starting a therapy. This ethical imperative means chiropractors must tell their patients firstly about the very limited evidence that spinal manipulations are effective; secondly, about the possibility of causing serious harm; and thirdly about other treatments which might be better. But who would give their consent, knowing all this? The way many chiropractors solve this dilemma is simple: they ignore the ethical imperative by treating patients without informed consent. There is evidence to suggest that ‘only 23 per cent [of UK chiropractors] report always discussing serious risk’.

How can this be? Chiropractic is a respected and well-established profession, you might think. True, in the UK, chiropractors have been regulated for many years by statute and have their own Royal College and General Chiropractic Council. But in July 2014, the Professional Standards Authority conducted an audit of the GCC and concluded that although the GCC’s operation of its processes had not created risks to public safety, ‘the extent of the deficiencies we found… raises concern about the extent to which the public can have confidence in the GCC’s operation…’

I have often said that the even the best regulation of nonsense must result in nonsense. The PSA’s verdict seems to support my view. As long as serious doubts about the value and integrity of chiropractic exist, we should remember an important foundation of health care: the precautionary principle. It compels us to use, whenever possible, only those therapies which demonstrably generate more good than harm. A critical analysis of the evidence shows that chiropractic does not belong to this category.

Edzard Ernst is Emeritus Professor of Complementary Medicine at the University of Exeter.


  • Ian G

    What about Osteopaths? I know a very good one who sorted my back pain.

    • Michael Potts

      Osteopaths work with the whole body, so their treatment is based on treating the root of the problem – which is normally related to posture, working conditions and other ground-up things. As a result you would have had far better results.

      • Martine Andersen

        I really hope your comment was meant as irony. Let’s be clear, your idea of what a chiro does is clearly disillusional. Chiropractors do head to toe treatment (some may chose to specialise in one area though, like someone in any other profession might do) we are not pure spine specialists. And we do not like to treat symptoms, the goal is to treat the cause and alleviate symptoms, just like any other health care profession would do. Google it or go visit an educational institution for chiropractic if you don’t believe me. But, lack of consent, clear misinformation, or harm is not good if caused by poor history taking, lack of education or information. Be my guest an report them to the GCC etc. But considering the number of treatments Chiropractors Perform yearly, it is actually a very safe profession, by looking at the data. Paracetamol kills more people or medical doctors by misdiagnosis or medical prescriptions. I am not against medications or doctors, but you can’t keep going around the world with a selective tunnel vision. Prof. Ernst will always try to ruin the profession regardless how much info or research you provide, but he also believes chiropractic is a treatment (I.e manipulations) and not a profession as it is viewed by most chiropractors. Which the means that osteopathy or a M.d, physio etc. who adjusts are just as bad and cause just as much harm. I use mobilisation, band stretches, massage, trigger point therapy, cbt, dry needling, graston, rehab etc etc. I did not attend a 5 year education and get a bachelor in human sciences to purely adjust people. It is a combination of approaches tailored for the individual right in front of you that makes the team and a good result. Please see talk to more than 1 chiro or more than 1 group of chiros that are evidence based to see that there as as much diversity within this profession as any else. 1 bad nurse does not make every nurse bad, and all swans are not white ;) do some research. In Denmark, Norway and Switzerland to mention some, chiropractors work alongside doctors at hospitals, write sick leaves, refer to specialists, work in rehab and work in multidisciplinary care. We see people before surgery to evaluate if treatment can be tried first, we reduce costs for the health care system and shorten down the time our patients are away from work. We are accepted, maybe not so much in the UK and US, but they also have lower requirements and less regulation within the profession.

  • shadsfan

    I have recently undergone laser light and infra red light therapy for spinal stenosis with extremely successful results. It has restored my mobility, is painless, non invasive and without side effects. It’s a little costly but well worth it. It is not yet mainstream medicine but I’d recommend anyone with back pain to investigate the treatment. The facility I go to has over 12,000 patients and is run by a qualified surgeon who now eschews surgery and has done so for over 20 years.

    • wearylondoner

      By the sound of it, you are paying for heat to be applied. A hot water bottle would be a lot cheaper!

      • shadsfan

        Not so, don’t be so skeptical. Laser therapy penetrates the soft tissue and sub-cutaneous areas of the back and into the spinal discs, tissue, bone and muscle. The laser light array generates no heat. I’ve tried heat packs and hot water bottles, they merely provide minimal temporary relief and the problem persists. I’ve also had this treatment for migraine and have reduced my medication requirement for the problem by 65%. Don’t knock it ’til you’ve tried it.

        • Heina Dadabhoy

          Can’t be around to knock it if you try it and it kills you, I guess.

        • ecafsub

          Garbage. It’s firmly in the “alternative” category, which means there is very little to no evidence to support any claims.

          That they’ve been embraced by chiroquacktors does not help their image.

          Don’t be so skeptical? How about you don’t be so gullible?

          • shadsfan

            Thankyou Doctor ecafsub, or are you really busface? Why are you Brits always so goddamned cynical when it comes to new and/or alternative technologies? It really holds you guys back you know. Or is this one more example of the British ‘green eyed monster’? I was in considerable pain, trouble walking, difficulty sitting in the cockpits of the aircraft I fly and even trouble climbing stairs. Around 8 sessions of the laser technology restored my mobility and enhanced my well being. I and over 20,000 other beneficiaries of the procedure highly recommend it. Your cynicism does you injustice………………..or perhaps not, given your uncalled for and unacceptable rudeness.

          • http://www.nightingale-collaboration.org/ Alan Henness

            How is it holding us back?

          • ecafsub

            Why certainly, Doctor shadsfan.

            Exactly how does your anecdotal data confer upon you a medical degree?

            As for rudeness, it’s okay for you to call people “skeptical”, but not call you “gullible”? Should I maybe have used the term “credulous”? Would that have been better?

            I was no more rude than you. Grow a pair.

            Pot. Kettle. Black.

            Chiro is not “new”, and it’s not “technology”. You are right that it’s “alternative”, and like all alternative therapies there is little to no evidence to support the wild claims chiros make. At all. Ever. Alternative medicine that works is called “medicine.”

            Chiro is nothing more than over-glorified massage, with the bonus risk of dead.

            Nice assumption, by the way, that I’m a Brit. What idiotic thought process led you to that conclusion?

          • shadsfan

            Nowhere in any of my comments did I refer to chiropractic but, having experienced it, I almost agree with your analogy. I only referred to Laser therapy. Pay attention.

          • UKSteve

            Err,,,

            1) I don’t think ecafsub is British, and
            2) I am – please see my posts.

            Bad generalisation there, shadsfan.

          • UKSteve

            “chiroquacktors”?

            You’re one of those people that use “librtard”, aren’t you?

          • ecafsub

            Nope

        • Will_Z_Macht

          What kind of laser, exactly? Because I can guarantee you that if you’re not feeling any heat, it’s not doing anything except shining a spot of light on your epidermis and not penetrating any further than regular light would and DEFINITELY not as deep as your discs. Lasers are just light. They are not magic. If that really did anything for you, it was a placebo effect. 100% guaranteed.

          • shadsfan

            None so blind as those who will not see I guess. The best I can do is point you to their website so that you can educate and enlighten yourself as to the procedure. 20,000+ patients, many of them doctors and surgeons, can’t all be wrong. See for yourself at http://www.bioflexlaser.com

          • Dys

            20,000+ patients, many of them doctors and surgeons, can’t all be wrong.

            The fact is that the scientific literature surrounding low level laser therapy is insufficient to assert that it’s of much use to anyone. Additionally, there’s the problem of what the actual mechanism is – how does it work?

            You’re using the same rationale as homeopathy proponents, and it’s just as flawed.

          • shadsfan

            I’m astounded and rather saddened by the somewhat vitriolic and clearly small minded cynicism by some posters comments here on the benefits of laser technology. For those in the UK take a good look at the website of The Back Pain Clinic in London at http://www.thecitybpc.com Click on ‘Bioflex Laser’ and view their video. Alternatively, or as well, visit http://www.bioflexlaser.com If you’re not then enlightened by any of the information neither I, or anyone else can help or convince you and you are clearly not willing to listen let alone understand the benefits. All new technologies (& this is not that new) require open mindedness and few on this post display that. Fortunately for me I was not that skeptical and, like the folks in the video, am free of pain for very little outlay. Regular medical practitioners were not able to provide that. Go figure.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Do they provide good evidence for its efficacy on their website?

          • shadsfan

            Alan, I can only suggest that you take a look and judge for yourself. From my own perspective I can vouch 100% for the efficacy.

          • http://www.nightingale-collaboration.org/ Alan Henness

            I have. I didn’t find any. What I did see were claims that could be in breach of the Advertising Standards Authority’s CAP Code.

          • Dys

            What are you, their spokesperson? You do realize you’re not behaving any differently than a homeopathy proponent, right?

            There’s a saying – “keep an open mind, but not so open your brain falls out”. The woo peddlers love to imply that anyone who rejects their magical cures is just close minded, but the truth of the matter is that they don’t have the facts to back up their claims. And in that particular vein, you’re following their playbook rather well.

            The truth in regards to low level laser therapy is as I stated – there simply isn’t enough reliable scientific research to support the claims that are being made on its behalf. You’re offering anecdotal evidence, which is fine, but it doesn’t, by any stretch of the imagination, establish the validity of the alternative medicine you’re advocating.

            Wackos that pledge their allegiance to homeopathy have quite literally made the exact same types of claims you’re making.

          • shadsfan

            I’m no spokesperson, merely a patient who’s endured extremely successful treatment. But what then, apart from a skeptic & a cynic (an unthinking & rude one at that) are you? You’re certainly no medical professional and clearly don’t have an enquiring mind. You also naively believe that this treatment is homeopathy. The two are poles apart, distinctly unrelated. I have never stated that it is LOW level laser therapy. Around the world over two million people have been successfully treated by this technology and relieved of pain and its symptoms. Your myopia keeps you in ignorance. You may recall that 50 or 60 years ago we could not have conceived of successful heart, liver, lung, and kidney transplants, or hand and face replacements. But medical technology advances, and these are now successfully achieved. The thinking man has, accepted these advances but it’s clear from your comments that you do not fall into that category or that you accept advances in medical technology. Let’s hope at some stage in your life you wise up and that you never endure pain that this procedure could relieve you of. Your first step however is to open your mind. I hope it’s not as hard for you as it appears.

          • Dys

            You’re certainly no medical professional and clearly don’t have an enquiring mind

            I’m not a medical professional, and never claimed to be so. You don’t strike me as one either. And you’re really insisting that because I’m not buying into your cheerleading routine for an unvetted alternative medical treatment, I somehow don’t have an inquiring mind? Please.

            You also naively believe that this treatment is homeopathy.

            No, actually, I didn’t. What I did say is that the defenses you’re raising about this treatment you’re raising are of the same type made by homeopath proponents. Including the accusing critics of just being close-minded.

            Your silly rant is nothing more than “medical science has progressed, therefore my anecdotal story about this treatment doesn’t deserve any scrutiny whatsoever”.

            The thinking man has, accepted these advances but it’s clear from your
            comments that you do not fall into that category or that you accept
            advances in medical technology.

            Actually, considering your attempt at an analogy is a complete failure, you’re wrong. You want to know what liver, heart, and lung transplants have behind them? A lot of definitive research. Want to guess what your preferred treatment lacks? I’ll give you a hint – it’s scientific research.

            Let’s hope at some stage in your life you wise up

            Let’s hope you come to understand that just because someone criticizes your pet treatment, that doesn’t imply that they’re myopic and close-minded. Your hasty, ignorant assumptions have led you to make rather stupid pronouncements concerning people you know nothing about.

          • shadsfan

            Your online moniker is appropriate for you and, enough for me. No more needs to be said.

          • Dys

            I agree. You’ve been more than adequately rebutted. Embarrassing yourself any further with more ignorance would be a mistake.

          • shadsfan

            Louis Pasteur, among others, was often ridiculed over his views, extensive labours and research on anthrax, hydrophobia, airborne bacteria etc., but eventually, despite professional obstacles, rebuttals and skepticism, was proven right. We assiduously follow his practices today over 120 years after his death. You should take note of a well known Pasteur quote, “In the field of observation, chance favours the open mind”. It’s the strivers, triers and open minded people in this world who advance us medically, not the skeptics and quitters who dismiss things out of hand. To your detriment you display all those traits.

          • Dys

            You continue to insist that being open-minded means agreeing with you on low level laser therapy. It doesn’t. So your insistence that I’m merely close-minded is, in reality, just a lie that you’re telling yourself.

            You notice that process you mentioned that Pasteur went through? That’s how science works. Your laser therapy hasn’t gone through anything approaching that yet. Your reference doesn’t even help your own case.

            And as I’ve already pointed out to you, you’re using the exact same tactics that homeopathy proponents use to try and discredit their critics. You’re not in good company.

          • shadsfan

            Nothing astounds me more than the narrowness of the English mind.

          • Dys

            I’m amazed that you can’t grasp such a simple concept.

          • UKSteve

            Nothing astonishes me, as an Englishman, as your stupidity.

          • Will_Z_Macht

            Ok… there’s nothing on that site that explains *how* it does what it claims to do, though. Further, I can’t find a single journal article detailing how this magical treatment works, either. Do you follow what I’m asking? I’m trying to find how light – which, even according to the website you provided, that’s all the treatment is – provides all of the benefits it claims to provide.

            I have been able to find research on infrared light therapy, but everything I’ve found (and I mean every single source) seems incapable of differentiating the results of said therapy from that of a placebo… as I said originally. It’s quackery.

      • UKSteve

        By the sound of it, you are unable to process complex ideas. Poor guy.

  • Mike Hall

    I used a Groupon offer to try out chiropractic treatment for myself (in Sutton, Surrey). It did immediately alleviate my back pain (later properly solved using shoe insoles) and I was walking straighter than before. He claimed that I had scoliosis, which the chiropractic treatment solved. However once the third and final treatment had been completed, the chiropractor quite aggressively tried to get me to sign a contract for a year’s treatment using tactics that I recognise from scam merchants: claiming that if I signed there and then without investigating further that I would get a discount. I refused, saying that I would prefer to consider the offer. At that point, he clearly became furious, snarling at me that I was turning down a great deal, and so I left as I was convinced that I was dealing with a scam merchant.

    The Groupon offer gave me a full body x-ray and 3 treatments but obliged me to watch a silly presentation claiming how brilliant chiropractic treatment was for the back and how it could cure young people completely. Later I went to my GP who was horrified by the fact that I was given an x-ray in this situation (with the accompanying radiation exposure). I went to the hospital (University College London Hospital) orthopaedic department who found that I had flat feet, which was throwing my spine out a little. The chiropractor would have continued treating the symptoms ad infinitum, claiming money for every treatment.

    Basically, I find that chiropractic treatment has exactly the same effect as a great massage but quicker (takes maybe 2 seconds), less pleasurably and with far more danger; though with more reliably excellent results. However, it is SYMPTOM-RELIEF ONLY as far as I can tell but it might be well worth it for those of us stuck hunched up in an office chair all day. The price I was offered slightly more than that for a half-hour sports massage from a reputable masseur (£30 per treatment with the special offer approx).

    • Ox-Bow

      I’m not sure which is the poorer decision, you using a Groupon to seek health treatment or the chiropractor that “advertises” with it.

  • http://www.nightingale-collaboration.org/ Alan Henness

    Prof Ernst said:

    “The way many chiropractors solve this dilemma is simple: they ignore the ethical imperative by treating patients without informed consent.”

    They cannot escape this imperative any longer. In Montgomery v Lanarkshire Health Board [2015] UKSC 11, the Supreme Court said:

    “82. In the law of negligence, this approach entails a duty on the part of doctors to take reasonable care to ensure that a patient is aware of material risks of injury that are inherent in treatment. … [there is a] fundamental distinction between, on the one hand, the doctor’s role when considering possible investigatory or treatment options and, on the other, her role in discussing with the patient any recommended treatment and possible alternatives, and the risks of injury which may be involved.

    83. The former role is an exercise of professional skill and judgment: what risks of injury are involved in an operation, for example, is a matter falling within the expertise of members of the medical profession. But it is a non sequitur to conclude that the question whether a risk of injury, or the availability of an alternative form of treatment, ought to be discussed with the patient is also a matter of purely professional judgment. The doctor’s advisory role cannot be regarded as solely an exercise of medical skill without leaving out of account the patient’s entitlement to decide on the risks to her health which she is willing to run (a decision which may be influenced by non-medical considerations). Responsibility for determining the nature and extent of a person’s rights rests with the courts, not with the medical professions.”

    Put simply, the patient has to be the one who makes the decision to consent to treatment, knowing all the risks and it is the doctor’s/chiro’s role to enable the patient to make an informed decision.

    For further details, see When the facts change…. by Nigel Poole QC: http://www.stopthesaatchibill.co.uk/when-the-facts-change/

  • http://www.facebook.com/moderateUV Sensible Moderate UV

    Great article.

  • Kat

    Compare “several hundred cases” (questionable) to the multitudes of people that have actually been killed by physician prescribed drugs, medical errors, in-hospital acquired infections, etc. and it really is no contest which practitioners do the most harm. I had chiropractic treatment that alleviated a lot of pain, no ill effects whatsoever.

    • Will_Z_Macht

      I think I’ll take my chances with proven effective with research and studies to back up the methods vs. proven ineffective to outright fraud.

      You can take your woo elsewhere.

      • Ox-Bow
        • Will_Z_Macht

          Enlighten me: how is someone supposed to treat a stroke they don’t know exists? I guess a chiropractor would spot it, right?

          OH WAIT… strokes are one of the leading causes of death after visiting a chiropractor.

          Do you see the difference there? ER doctors may MISS a stroke already in progress. Chiropractors are CAUSING strokes.

          But yeah. It’s not like real medicine developed techniques to stop strokes in progress, mitigate them if no immediate treatment is available, and help people recover afterward. Nope nope nope!

          • UKSteve

            “Chiropractors are CAUSING strokes.”

            “Moronic comment alarm” went off – proof required.

          • Will_Z_Macht

            Did you even read the article? But wait! There’s more!

            http://whatstheharm.net/chiropractic.html

          • UKSteve

            No I didn’t – past teh first 2 paragarphs – I’ve seen Ernst for what he is, as posted above.

            Hold on…..

            From that link….“368,379 people killed, 306,096 injured and over $2,815,931,000 in economic damages”

            Chiropractic has caused ? 360,000 deaths and $3 billion of damage? Seriously? Which pharma co. do you work for?

          • Ox-Bow
          • Jem

            You want proof? Talk to Kristi Bedenbaugh. Oops, no you can’t. She was dead at 24. From a stroke. A stroke caused by a chiropractor.

            “An autopsy showed that the chiropracter’s manipulation had split the inside walls of both of her vertebral arteries.”

            That moronic comment alarm of yours was probably ringing because of your own comments.

      • Martine Andersen

        I was going to say! Hehe doctors know very well that a lot of the things they do and prescribe have very little evidence. It is the sad truth. Not everything manual medicine does works for everyone either, but hey NO ONE is a magician ;) there is also something called risk vs benefit.
        But People needing help for infections, fractures, fevers, organ problems etc that has nothing to do with the musculoskeletal system
        Or is movement based, shouldn’t be anywhere else but at the Drs office or at the hospital

      • ChrisTavareIsMyIdol

        “Proven effective treatments” like Thalidomide maybe?

      • Kat

        Ah, you suffer from the delusion that science is unbiased. Tell that to the thousands and thousands of people who have been harmed or killed by FDA-approved pharmaceuticals, cancer treatments, etc.

        • Will_Z_Macht

          No, I don’t. I’m fully aware that the FDA isn’t is rigorous as it should be.

          Here’s the thing, though: most medicine works exactly as intended… and with research, it’s improving every *day*. Conversely, aided by suckers like you, homeopaths and chiropractors are KILLING people every day… either through pushing medicine that contains no medication, performing treatments that physically injure people if not outright kill them, or convincing their patients not to seek the medical attention that WOULD actually heal them!

          Further: yes, sometimes real, bona fide doctors end up killing people, too. It’s rare, but it does happen. And they go to jail, just like the diploma mill “doctors” do, too.

    • http://www.nightingale-collaboration.org/ Alan Henness

      Kat said:

      “Medical care is the 3rd leading cause of death in the United States:”

      Odd that the CDC don’t even put it in the top ten:

      Number of deaths for leading causes of death (2013)

      Heart disease: 611,105
      Cancer: 584,881
      Chronic lower respiratory diseases: 149,205
      Accidents (unintentional injuries): 130,557
      Stroke (cerebrovascular diseases): 128,978
      Alzheimer’s disease: 84,767
      Diabetes: 75,578
      Influenza and Pneumonia: 56,979
      Nephritis, nephrotic syndrome, and nephrosis: 47,112
      Intentional self-harm (suicide): 41,149

      http://www.cdc.gov/nchs/fastats/deaths.htm

      • Kat

        Yes, interesting that the CDC does not include medical errors in the top causes of death when many other reputable sources do, for example http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx

        Why do you think that might be? Here is an interesting read: http://www.jopm.org/opinion/commentary/2013/04/24/it%E2%80%99s-time-to-account-for-medical-error-in-%E2%80%9Ctop-ten-causes-of-death-charts/

        • http://www.nightingale-collaboration.org/ Alan Henness

          Your links talk about hospitals so, whilst interesting, are irrelevant to a comparison with chiros.

          • Kat

            It is relevant to the point that those trying to discredit chiropractic because of, as the article states, “several hundred” cases of injury fail to comprehend or acknowledge the sheer number and gravity of the supposedly superior conventional medical system.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Only in the same way that a petty burglar demands lenience for his crime by pointing to the Great Train Robbery…

            What is at issue is, as Prof Ernst clearly states, the harm-benefit balance for chiropractic.

          • Ox-Bow

            Yet he cites no peer reviewed evidence other than his own ‘blog.’ He is continually reinforcing his own flawed thought processes while only occasional offering new information that fits his preconceived notions. That is what we call irrational belief.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Yes, this is the Spectator, not a peer reviewed journal.

          • UKSteve

            It isn’t at issue. He’s paid to rubbish non-conventional medicine, and he serves his government masters / big pharma “research” funders, well.

          • http://www.nightingale-collaboration.org/ Alan Henness

            UKSteve said:

            “He’s paid to rubbish non-conventional medicine”

            Oh? I don’t suppose you have evidence to back up your nasty accusation, do you?

          • UKSteve

            I see you’re a down-vote obsessive. How infantile.

            Now I understand why your obsessing on this page:

            “Although we have access to experts in many different fields, the Nightingale Collaboration consists of just Alan Henness and Maria MacLachlan.”

            Couldn’t you find any more people to share your utterly bizarre views, and rather juvenile debating skills….responses?

            http://www.naturalmatters.net/news-view.asp?news=4136

            http://www.truthwillout.co.uk/edzard-ernst-the-quack-professor-retires-defeated/

          • http://www.nightingale-collaboration.org/ Alan Henness

            Oh! Is there a limit on how many comments I’m allowed to up or down vote as I see fit? Perhaps you’d run the Spectator differently…

          • UKSteve

            A very typically juvenile response to a minimalist observation and assertion – now proven.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Why did you raise it then?

          • UKSteve

            To prove that you are something of a juvenile.

            I notice you skipped the proof. Your credibility has gone right down the toilet with all of your silly posts – to what extent (if any) is your 2-man (well, 1 woman and 1 man) outfit funded by pharmaceutical companies?

          • http://www.nightingale-collaboration.org/ Alan Henness

            LOL! But I see you didn’t bother to read very much on our website.

          • UKSteve

            Why would I red that, when I and close one’s have so much positive experiences of complementary therapies, and so much bad experience of doctors?

          • http://www.nightingale-collaboration.org/ Alan Henness

            It would answer the very question you asked. But it doesn’t matter.

          • UKSteve

            Exactly. No answer.

          • http://www.nightingale-collaboration.org/ Alan Henness

            You could try using Google…

          • Maria_Maclachlan

            The answer to your utterly juvenile question is “none”. Defenders of the indefensible always resort to conspiracy theories and insults because they have nothing else. Poor you.

          • UKSteve

            You need that dictionary really badly, as you’ve no idea what “conspiracy theory” means (such big words, though)

            Not sure why your clueless and infantile colleague was so coy about answering.

            ‘Poor me’? I think you pair are tragic, having seen the infantility of your posts, and utterly bizarre nonsense you are peddling, by pretending to understand science.

          • Maria_Maclachlan

            LOL! I’m beginning to think you are an anti-CAM campaigner who is pretending to be a pompous, condescending and scientifically illiterate ass in order to give CAM promoters a bad name. If you really believe what you’re saying, I should bill you for a new irony meter. ;-)

          • Jem

            Your conspiracy theory is that the people saying things you don’t like are being paid to say them. At least that’s what you’re pretending to believe though I very much doubt that you are dumb enough to really believe that – nobody is.

          • Jem

            Yawn! You make a pathetic troll. At least try and be witty in your insults as others have been in their insults to you.

          • Maria_Maclachlan

            Actually we could find more people to share our concern at the falsehoods being promoted by those who line their pockets selling quackery to members of the public. Do you know, for example, the number of complaints our supporters submitted to the ASA against homeopaths. Google is your friend. ;-) Calling someone a “vote-down obsessive” sounds pretty infantile to me but each to their own, I guess. It’s strange that you find asking you to support your assertions “juvenile”, however.

          • UKSteve

            “Actually we could find more people to share our concern at the falsehoods being promoted by those who line their pockets selling quackery to members of the public.”

            What falsehoods? Many posts on here show that people have benefited greatly from CAM, and chiropractic in particular, bet recognise that quacks exist everywhere. Here, meet one:

            http://www.telegraph.co.uk/news/health/news/11216096/Foreign-doctor-Daniel-Ubani-still-a-killer-and-charlatan-despite-German-court-ruling-says-victims-son.html

            What you brain-donors are doing is beyond reckless and foolish, buy tainting everyone who practices this as “quacks” – it is stupidity with a level of viciousness applied.

            If you’re attacked in the street by by someone who is Afro-Caribbean, do you assume all muggers are ‘black’? This is the exact mindset you are applying to CAM, which has an extraordinary amount of success, and I know is highly regulated.

            You Ernst cultists aren’t even providing a service, you’re just bizarre. So I’ll ask you, as you’re boyfriend didn’t answer: are you or you Nightingale outfit in receipt of any government or pharmaceutical or General Medical Council funding?

          • Maria_Maclachlan

            “What falsehoods?” Falsehoods are claims made without robust supporting evidence. In the field of healthcare, making claims that x treatment can treat y condition without good evidence to back it up is dangerous and irresponsible. Sorry you seem to have trouble grasping this.

            “If you’re attacked in the street by by someone who is Afro-Caribbean, do you assume all muggers are ‘black’?” No, of course not.

            “This is the exact mindset you are applying to CAM”. No, it isn’t. But allowing promoters of therapies to make unsupportable claims without challenging these and reporting them to the regulatory authorities is akin to standing by and watching someone getting mugged and doing nothing to help.

            “which has an extraordinary amount of success” It certainly does not have an extraordinary amount of success in treating serious conditions as claimed by so many promoters of these “therapies”. It is a thoroughly dishonest industry.

            “and I know is highly regulated.” No, it isn’t highly regulated – it is very poorly regulated and you have no evidence to the contrary.

          • Maria_Maclachlan

            Have you nothing but ad hominems? Provide one iota of evidence that Edzard is paid by either the government or big pharma. You can’t. Shame on you.

          • UKSteve

            There are no ad hominem attacks here – look it up in a dictionary (book of words).

            As I’ve said 3 times for you rather dense and clueless people, I’ve already provided it. You came to the discussion late, not my problem.

          • Maria_Maclachlan

            I know what an ad hominem is and every time you allege that someone you disagree with is paid by Big Pharma or the government you are committing an ad hominem fallacy. You have not provided evidence for these allegations because no such evidence exists outside your fevered imagination. I suggest a remedial class in critical thinking for you. I’d offer to teach you myself but I only take advanced students.

          • Jem

            You may have said three times that you’ve already provided it but you haven’t actually provided it. Don’t think we can’t spot a liar backed into a corner when we see one.

          • Jem

            Ernst is retired, you ignoramus. That blog is an unpaid hobby and it is full of references to scientific papers, as you would know if you weren’t so wilfully blinkered.

          • UKSteve

            So….you replied to Kat’s first post, but when you were shown to be completely wrong, you say her second (related) post ifs off-topic?

            Yes, I think we have your measure…

  • Ox-Bow

    “Regrettably, the hard evidence is not as solid as one would wish. In conventional medicine we have effective systems to monitor adverse effects of all interventions — not so in alternative medicine. Therefore, the true frequency of such tragedies is anyone’s guess.”

    Mr. Ernst really has no idea what he is talking about. His feeble opinion has left the obscure biased world and entered into the realm of absurdity. There is no-evidence of cervical dissection in current scietific literature. In fact the evidence is the opposite. http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation

    • http://www.nightingale-collaboration.org/ Alan Henness

      So are there systems in pace to systematically monitor harms?

      • Thinking_Chiro

        There is a lack across all professions chiro, physio and GP’s. Discussed here:
        https://www.mja.com.au/insight/2014/7/support-chiropractor-reporting

        There are some good proposals in the comments section!
        Chiropractic is just the flavour of the month on this topic that has highlighted a need across all professions!

        • http://www.nightingale-collaboration.org/ Alan Henness

          In the UK, the CQC monitor, inspect and regulate what doctors do and the Yellow Card system records AEs from drugs. Chiros are exempt from CQC inspections because they are considered CAM and there is no systematic method of recording AEs. As Prof Ernst says, that means there is no way of knowing the true level of harms and the regulator doesn’t appear to be at all interested in doing anything about it.

      • John B

        There definitely are systems in place. In the UK, it seems you are somewhat behind the times on that, but that is to be expected, ( I mean you guys are are only now realizing the positive effects of dental hygiene, right? ;-). I would think you’re not up to speed on current CAM therapies. However one system in place in the US could be considered malpractice insurance. Insurance companies that issue these policies are constantly regulating premiums based on claims. A chiropractor does not want to pay high premiums. A Chiropractor who harms people, I assure you, will not be in business for very long. Incidentally chiropractors pay the lowest malpractice premiums than any healthcare provider as the actual threat of harm is statistically rare. Insurance companies constantly monitor this .

        But more to your point, in the states, each of the 50 states has a government regulatory board for chiropractors. Here in Texas, it is called the Texas Board of Chiropractic Examiners (TBCE). It is staffed with two chiropractors, several laypeople, attorneys, and experts. It’s sole purpose is to protect the public from potential harm. Every chiropractor is issued their license through that board. They post their disciplinary actions each month on their website.

        • http://www.nightingale-collaboration.org/ Alan Henness

          John B said:

          “There definitely are systems in place. In the UK, it seems you are somewhat behind the times on that”

          Please feel free to link to somewhere that shows there is a systematic system for monitoring and reporting harms.

          • John B

            As I mentioned, in the UK it seems you guys are somewhat behind the times. I don’t know of your regulatory procedures, if any. But I edited the post to include a link. You can Google any of the 50 boards in the United States for similar links. But admittedly, a “systematic system” seems a bit redundant for any profession. But I guess that’s what governments are.

          • http://www.nightingale-collaboration.org/ Alan Henness

            John B: Apologies – I misread your comment as if you were saying I was behind the times.

            But your Texas link doesn’t show that there is any system in place to systematically record harms: it appears to be just a regulator acting on complaints. We have a statutory regulator in the UK that supposedly does that (but it can’t levy fines), but they don’t have a system of AE monitoring and there are no signs they are at all interested in setting one up.

          • UKSteve

            Any system will be systematic.

          • Jem

            Not necessarily – the word “system” is commonly misused. Homeopathy, for example, is described as a “system of medicine” even though there is nothing systematic about it. There could be a “system” for reporting CAM AEs which is actually a dead end. But there isn’t even that in the UK.

        • Maria_Maclachlan

          ” I mean you guys are are only now realizing the positive effects of dental hygiene, right? ;-).”

          Actually, no. ;-) https://www.washingtonpost.com/news/to-your-health/wp/2015/12/16/jokes-on-us-american-teeth-are-as-bad-as-british-teeth-study-says/

        • Nick_Tamair

          HI John. We don’t have state regulation of chiropractic for the same reason we don’t have state regulation of astrology.

      • UKSteve

        There is for ALL alternative therapies, and it’s been in place since the 1970’s.

        • http://www.nightingale-collaboration.org/ Alan Henness

          Where?

          • UKSteve

            Google is your friend.

          • http://www.nightingale-collaboration.org/ Alan Henness

            LOL! The last resort of someone who can’t back up what they claim?

          • UKSteve

            No. It’s there, I know form personal experience. Let’s see if you’re an infant or an adult.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Yep.

          • Maria_Maclachlan

            I’ve tried googling and can’t find it so why don’t you stop acting like an infant and provide a link?

          • UKSteve

            Then you haven’t tried hard enough, which don’t you stop acting like a child and try harder. I know this is difficult, poor poppet!

          • Ken_Rodbender

            you should change your name to UKSteveTheCunt

          • UKSteve

            Wow! Very mature, nuanced and reasoned.

            Nah, just kidding.

            A whole 53 posts in your history and most of them abusive. Has your mummy taken your Lego bricks away for being naughty?

          • Ken_Rodbender

            LOL! points? oh man are you serious? You should lick my butthole for 50 points you cornball.

          • UKSteve

            Ah, I see. You’re off your meds, and bouncing off the walls. Figures.

          • Ken_Rodbender

            lol I KNEW IT! You ARE an expert on penile grading. So what happened to this comment, did it reveal too much of your expertise? You got scared the comic mods might PENalize you? I hope you lost 25-100 points for being a huge pussy.

          • UKSteve

            Just checked – no mention of size. Perhaps if someone had taught you to read something – you know – other than Batman comics.

            Still, not your fault you’re from Wisconsin. Oh…..hold on….

          • Ken_Rodbender

            gross man, quit being a creepy stalker. Unhide your weak ass account so everyone can see exactly what city UKSteve watches little kids play in the park.

          • UKSteve

            Oh yes, you’re definitely American.

            “…bender”! LOL!

          • UKSteve

            Top modding on this comic site. They allow industrial-grade bell3nds like you on it.

          • Maria_Maclachlan

            Yes, it is difficult so why not give me some help, superior one? Why be so mean-spirited as to refuse to back up your claim that there has, since the 1970s, been in place a system for recording AEs “for ALL alternative therapies”? I’m sure it can’t possibly be because you’re mistaken or even deliberately lying, so what exactly is the problem with a simple request to provide a straight answer?

          • Maria_Maclachlan

            Still waiting….

          • UKSteve

            Can you hold your breath?

          • Jem

            Why don’t you just pretend to be an adult and admit you were wrong? It’s pretty obvious to everyone that you are and now you just look like a bellend because you won’t admit it.

          • Jem

            No, there isn’t. I know from personal experience.

    • Maria_Maclachlan

      It’s Dr Ernst. He isn’t a surgeon. And he certainly knows what he is talking about. I’m not sure that you do.

  • Douglas John Scown

    Ernst. Groan. On the subject of the chiropractic profession he has an almost pathological tendency to be bewilderingly biased. I write a blog in which I generally kick the shit out of the roughly 20% of my profession who bang on about mystical bullshit but Ernst either failed entirely or ceased at some point to notice that his evidence for widespread catastrophic harm is a myth (according to him my hallway is littered with corpses) and that for efficacy quite high compared with other approaches to NMSK care (leaving aside the issue that many don’t even use HVLA manipulation but other professions do (yet are NEVER mentioned – surprise surprise)). A cogent discussion is impossible due to the constant red herrings. We may as well be wearing ‘JEW’ on our jackets such is the standard of intellectual honesty. I too doubt the ability of the profession to regulate the myth makers but it’s simply false, deceptive and misleading to boost claims of terrible harm whilst simultaneously claiming ‘it’ (as if an entire profession could be reduced to a single intervention (Duh)) does absolutely no good. He has a book to sell and unfortunately he has allowed that to turn him into exactly the same animal as the idiots who occupy the nutty part of the spectrum.

    • http://www.nightingale-collaboration.org/ Alan Henness

      Douglas John Scown said:

      “Ernst. Groan. On the subject of the chiropractic profession he has an almost pathological tendency to be bewilderingly biased.”

      Can you give an example of this bias?

      “I write a blog in which I generally kick the shit out of the roughly 20% of my profession who bang on about mystical bullshit”

      That’s a sizeable proportion. Is it increasing or decreasing?

      “but Ernst either failed entirely or ceased at some point to notice that his evidence for widespread catastrophic harm is a myth”

      What are the levels and type of harms and how do you know?

      “(according to him my hallway is littered with corpses)”

      Where does he say that?

      “and that for efficacy quite high compared with other approaches to NMSK care”

      Is it? Citation required.

      “(leaving aside the issue that many don’t even use HVLA manipulation”

      What proportion don’t use HVLAs?

      “but other professions do (yet are NEVER mentioned – surprise surprise)).”

      Prof Ernst does. See for example: http://edzardernst.com/2013/11/spinal-manipulation-for-back-pain-who-does-it-best-chiros-physios-or-osteos/

      “A cogent discussion is impossible due to the constant red herrings.”

      What red herrings?

      “We may as well be wearing ‘JEW’ on our jackets such is the standard of intellectual honesty.”

      Pretty close to a Godwin!

      “I too doubt the ability of the profession to regulate the myth makers”

      They could, but choose not to.

      “but it’s simply false, deceptive and misleading to boost claims of terrible harm whilst simultaneously claiming ‘it’ (as if an entire profession could be reduced to a single intervention (Duh)) does absolutely no good.”

      But do you agree that what matters is the balance between benefit and harm? If so, perhaps you could provide good evidence for both?

      “He has a book to sell and unfortunately he has allowed that to turn him into exactly the same animal as the idiots who occupy the nutty part of the spectrum.”

      And chiros have businesses to run, so what’s your point?

    • norway campisi

      BRAVO

    • mikerbiker

      Ernst’s story is pretty fascinating- didn’t he start out as a homeopath trying to show that alternative medicine worked- and realized it didn’t based on this scientific studies?

      • Maria_Maclachlan

        He started as real doctor who, like many in his native country, believed there must be something in a range of complementary therapies and whose hands-on experience in a homeopathic hospital seemed to confirm it. He fully expected that scientific studies would support at least some of the therapies but was disillusioned. In other words, far from being biased as the quacks claim, he has simply been guided by science and reason and won’t be bullied into science but those who have too much invested in quackery and who don’t share his ethical approach.

        • Leif Olav Jøsang

          Being bullied into science is of course a terrible ting! :D

          • Maria_Maclachlan

            LOL! I hope it was obvious I meant to type “silence”. I’ve now edited it, thanks. :-)

  • Joe Glowiak

    This article does not contain any legitimate citation for a study supporting its claim in the subtitle: “In several hundred cases patients have been seriously and often permanently damaged.” This article appears to be strongly opinionated, without objective data leading to the opinions expressed. The articles cited should be peer reviewed. I am not saying chiropractic treatments contain no risk, but for the amount of good that I have witnessed coming from the profession, the cases of harm seem infrequent.

    I personally receive chiropractic care and feel that my chiropractor is competent, safe, and genuinely looks after my health. He spends time with me and explains what is happening and he’s been keeping me functional. I can walk and bend without pain. I feel healthier because of the rehab exercises he has suggested and all of the work we have done.

    The article does not include any first hand account of chiropractic care. Even if it did, each chiropractor practices a little differently. Therefore, the risks with one chiropractor may be different than the risks with a different one. The risk of having surgery with one surgeon are different than the risks of having the same surgery with another surgeon. The types and manner of care provided by chiropractors are somewhat varied within a range. Chiropractors also use their clinical judgement as to the types of treatments their patient ought to recieve. Not every patient will recieve the same care, because each patient has individual needs. Each patient may have more or less risk of an adverse response to treatment, and chiropractors are educated about identifying risks. Even so, some chiropractors are more skilled at this than others. Therefore, do not let some chiropractor mistakes or misfortunes deter you from seeing a different chiropractor that seems capable of delivering safe, effective care. Everyone makes mistakes…but my chiropractor makes an effort to minimize potential adverse effects from treatments, and he does a great job communicating about this with me.

    • http://www.nightingale-collaboration.org/ Alan Henness

      Much of the evidence is cited and discussed on Prof Ernst’s blog: edzardernst.com

      You may also learn something about the difference between good and poor evidence.

      • Joe Glowiak

        A blog is not a peer reviewed journal. Also, my cursory scan of this particular blog gives me the impression that it is likewise sarcastic and opinionated and not direct or substantially factual.

        • ateo

          And your anecdotal evidence isn’t a rebuttal…

          • UKSteve

            But anecdotal evidence is not “absence” of evidence.

          • Mike E

            That comment is so vacuous that it’s not even wrong, as theoretical physicist Wolfgang Paul once said.

          • UKSteve

            Your response is so patently moronic, it isn’t worthy of a genuine reply. Another Nightingale acolyte who pretends to know something about science (LOL!), rocks up to upvote its two resident cretins. Hilarious.

        • http://www.nightingale-collaboration.org/ Alan Henness

          LOL! That is amusing.

        • Chin Tsung Jern

          Lol, do you even know what cited means? It means that though found on a blog, Prof Ernst has taken great care to let his readers look for the articles that he’s citing, many of which comes from peer reviewed journals.

        • UKSteve

          Not surprising. This is what Ernst had to say about Saw Palmetto in 2005:

          Table 2: Preventing patients from receiving the best available healthcare

          Not using CM that has been shown to do more good than harm

          – Saw palmetto is effective and safe for BPH, but in the UK it is hardly used

          Saw Palmetto was found later to be useless for men’s prostate health.

          What scientific evidence did he use to draw this conclusion?

          http://www.healthwatch-uk.org/20-awards/award-lectures/54-2005-prof-edzard-ernst.html

      • UKSteve

        You might learn something about science and it’s corruption – by staying away from this government-funded clown.

        His sole purpose in life is to take government research money with the objective of ‘discovering’ that alternative therapies – whatever they are – don’t work. Some of them may be highly questionable (homeopathy?), and some are just plain practised by charlatans.

        One of my mates has had fantastic results with acupuncture and chiropractic, for a bad back and he says it’s ****ing great. If he goes to his doctors, he gets an x-ray (if he’s lucky) and a prescription for Valium (Diazepam). His mother tried medical herbalism (naturopathy) years ago – swore by it for arthritis and gout.

        The reason he (Ernst) is doing this, is to stop pressure from getting alternative treatments put on the NHS – which the great Prince Charles suggested decades ago.

        • http://www.nightingale-collaboration.org/ Alan Henness

          UKSteve said:

          “His sole purpose in life is to take government research money”

          Again, any evidence for your nasty accusation?

          • Maria_Maclachlan

            You already know there isn’t.

          • Truth Be Told

            Aren’t you married to Al Henness, Maria? Weren’t you the “author” of this frightening, and despicable, post:
            http://fighting-for-homeopathy.blogspot.com/2015/10/homeopathy-skeptics-are-everywhere.html
            Very weird…and sad.

          • Maria_Maclachlan

            Yes to both. What exactly do you find weird and sad about either of those facts? :-)

          • Jem

            Ah! So in your world, telling someone who harasses, abuses and lies about people – including recently bereaved parents – that they are nasty and stupid is ‘frightening, despicable, weird and sad’ ? What words would you use about the person who actually did and continues to do all these things? I suppose you think it’s OK to continue to harass and sneer at a young couple devastated by the loss their child. For shame.

        • Mike E

          Here we go, we are now in conspiracy territory.

          • http://www.nightingale-collaboration.org/ Alan Henness

            It’s always a good – but predictable – diversion, isn’t it?

          • UKSteve

            You might be, but that’s understandable given the ridiculousness of your response.

      • disqus

        Off topic but the only recent place I found your comments in DT

        Update

        Swiss to recognise homeopathy as legitimate medicine

        29 March 2016

        http://www.swissinfo.ch/eng/complementary-therapies_swiss-to-recognise-homeopathy-as-legitimate-medicine/42053830

        • http://www.nightingale-collaboration.org/ Alan Henness

          Indeed. Homeopaths have been all over this today. Pity they don’t quote this bit of the article:

          “The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. It has therefore opted to accept them on par with other medical disciplines. It plans to continue allowing reimbursements of treatment costs by compulsory health insurance, provided they are administered by certified medical professionals.

          However, as is the practice for conventional medicine, certain controversial practices under these complementary therapies will be subjected to further scrutiny. The ministry has initiated a consultation process – open until June 30, 2016 – on the proposed modification of the regulations.”

          I wonder why homeopaths didn’t simply provide the evidence required…

          • disqus

            Ja, Wunderbar ! I just hope it is never imposed without patients’ knowledge and consent.

            I was pleased to discover through a heated/friendly debate in my local newspaper with an ‘expert’ that my house doctor does not support homeopathy although I don’t know his views on other complimentary treatments but I am sure he can guide patients in the right direction if that is what they want. The practice seems very widespread here where many have great faith in these alternative treatments and their practitioners. Only I am the sceptic having seen the results of too many that have failed to work or have gone badly wrong. pharmacies usually have a large section dedicated to these products. I am not sure whether they they can be sold over the counter or whether they are on prescription only, probably a bit of each just like other medication. They often have promintbdilays in their shop windows. On reflection, the fact they are in the front of the shop rather suggests the former. Perhaps I will ask next time I have occasion to visit a pharmacy!

          • http://www.nightingale-collaboration.org/ Alan Henness

            Not sure of you’re in the UK, but there are something like 220 registered and 20 authorised homeopathic products in the UK and they are all available over the counter. All other homeopathic products are unlicensed medicines and should not be advertised, sold or supplied (essentially) except by someone with independent prescribing rights (essentially medical doctors). Sadly, all to many pharmacies advertise the sugar pills: many won’t believe in them of course and some need the profit, but I’m sure it would help if they distanced themselves from all quackery.

          • disqus

            I speak of Switzerland where there are shelves visibly full of products in most pharmacies and of which all are presumably licenced. This is also the case in other surrounding European countries. Many homeopaths and other complementary medicine practitioners here hold dual medical, nursing, or I believe physio qualifications and there are also recognised professionals in their own right. Such therapies are often offered in parallel with traditional medicine although it used to be offered rather more informally and covertly in public hospitals. However recognition by insurance companies has changed this practice.

          • disqus

            Popped into a Swiss pharmacy yesterday, of which we have eleven for a population I believe to be around 20,000, and excluding many of the other further outlying villages ehich have their own pharmacies. As previously said, the main ones all have a substantial homeopathic section as well as the usual large section of other over the counter medicines and vitamins and minerals, etc. The pharmacist informed me none of the homeopathic products required a prescription which seems strange if they want these products to be taken seriously. They are all in very simple packaging so a novice would not have a clue what to buy although presumably the pharmacists are qualified to give some advice. I would also presume in order for an insurance claim Prescriptions would be required, as for all other medication, from a recognised practitioner and of whom many here are medical professionals and often GPs who regard it as an interesting and lucrative sideline to support their very costly overheads. The pharmacist on Sunday on call was rather busy so I didn’t like to bother him with too many questions.

          • http://www.nightingale-collaboration.org/ Alan Henness

            The SBC announcement states that reimbursement is only for treatments administered by certified medical doctors. Unfortunately, this will probably just give OTC homeopathic products even more undeserved and unearned legitimacy!

          • disqus

            It is quite complicated as there are cantonal differences in regulation of CAM. I haven’t been able to find out through Google how many licenced medical practitioners are CAM trained in Switzerland but according to the CAMDOC Alliance between 25-40% prescribe homeopathy without any formal training or certification.

            Sorry was going to quote the figures but couldn’t return to the page but this is the link.
            http://www.camdoc.eu

          • disqus

            Just tacked a bit onto end of my comment!

    • Coachella Zimbo

      Well said. But you know, the majority of people don’t require evidence for extraordinary claims. People are irrational and quick to jump to conclusions. I imagine this post has been shared thousands of times by those who believe the info to be true, sources or no sources.

      • Joe Glowiak

        You’re probably right, Coachella. :/

    • norway campisi

      right on!

    • mikerbiker

      He performed a peer reviewed meta-analysis of Chiropractic spinal manipulation for neck pain in 2003: http://www.ncbi.nlm.nih.gov/pubmed/14622659

      “In conclusion, the notion that [Chiropractic spinal manipulation] is more effective than conventional exercise treatment in the treatment of neck pain was not supported by rigorous trial data.”

    • mikerbiker

      A search of Pubmed reveals 65 papers that Dr. Ernst has authored or co-authored that mention chiropractic http://www.ncbi.nlm.nih.gov/pubmed?term=(ernst%5BAuthor%5D)%20AND%20chiropractic

    • Disqust

      The statement ‘I personally receive chiropractic care’ indicates that your views are not impartial.

      • Ox-Bow

        Can ‘views’ ever be impartial? I mean unless you are a programmed robot, of course…..

      • UKSteve

        That statement indicates that you have an empty head.

        • Disqust

          Loser.

          • UKSteve

            And as if to prove my point perfectly…..

  • http://www.techrebellion.net Keith Dickens

    I am not completely sold on all the voodoo of Chiropractics either but I can confirm that they have value. When I tripped carrying a heavy load down some stairs, a medical doctor put me in an aircast where I stayed, in pain and unable to properly walk, for 4 weeks. One trip to a chiro snapped my ankle back into place and I walked out of the office nearly pain free and without the aircast.

    Also, I think you should keep the whole ’30 deaths’ thing under wraps because I hate to tell you this but way more people die visiting their doctor for outpatient procedures and clinical visits.

    • Nilesh Jambhekar

      Your point might have validity if you had compared lives saved to deaths caused. Do it for doctors vs. chiropractors. Then do the same thing with morbidity. Furthermore, sample size one (what you experienced) is not a valid sample size in a methodology to determine effectiveness if numerous randomized control trials as well as meta analysis don’t support your conclusion.

      That being said, doctors don’t advocate nearly enough for non medical therapies to improve well being. It would be good if we, as a society, moved away from our exceedingly unhealthy lifestyles.

  • Paul

    I don’t view chiropractic treatment as alternative. It does have risks but in my case far less than the pain relieving drugs I no longer have to take!

  • Thinking_Chiro

    Studies from the Uk, Denmark, France, Canada, Switzerland, US and Australia all consistently place the fringe element at 15-18% of the profession. That is 15-18% too many IMHO! Critics both within and without the profession are vital to reform, but criticism must go hand in hand with support for reform. Carpet bombing the profession with sweeping statements has the
    reformers within the profession as unacceptable collateral damage and does not further reform!
    The studies showing temporary soreness in 50% of patients following treatment match similar studies by the physiotherapists! So no surprises and I discuss this with patients! Seroius adverse events are also discussed and My informed consent form is on its 6th revision and I have been doing it as standard since 1995.

  • Troy Bratten

    Zero evidence for this article. The author is too full of his own ego to admit the value of chiropractic. Johns Hopkins did this study below, in complete disharmony with this author’s points:

    http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation

    It really is a shame there are medical practioners out there that think their shit doesn’t stink; as if medicine doesnt have side-effects and MDs are perfect docs. They clearly are not (we are all human) and medicine has serious risks too; stop being so ignorant and emotional, and stick to science please. Chiropractic stands to science. Just look for yourself in pubmed – it’s free.

    • UKSteve

      Great post!

    • Maria_Maclachlan

      Actually it’s precisely because the author is guided by the weight of scientific evidence and has no vested interest in chiropractic or anything else that he is able to objective and doesn’t need to cherry-pick evidence to support a particular point of view. It’s a shame that you feel the need to resort to personal insult and non sequiturs about MDs but at least it guarantees you won’t be taken seriously by any but the most blinkered supporters of quackery.

  • Operatenor

    I had a chiropractor who saved my life, back in 1992; this is no exaggeration.
    He happened to be one of the good ones, who never claimed to be able to cure everything by adjusting one’s spine.
    To make a long story as short as possible: I had acute lower back pain, which was mis-treated at first by a hospital. After I was sent home, still in pain and unable to use my legs, my chiropractor called me daily to check my progress. After five days of deterioration, he order me to come see him. Since I couldn’t get out of the car, he came out to the parking lot, took one look at me and decided this was out of his league. He then called his golfing buddy, who happened to be chief of orthopedics at a nearby hospital, and the best back specialist in the county, and had me admitted to the hospital through the ER.
    It turned out I had MRSA before it was known, and an abscess in my spinal canal at LS, which was also infected. It was a matter of days from rupturing, and would have killed me in less than 45 minutes had it ruptured. A laminectomy was performed to drain it, and 10cc was drained.
    The orthopedic surgeon opted not to fuse my vertebrae, but rather sent me back to my chiropractor once I was sufficiently recovered, and he put my lumbar spine back in proper alignment.
    Today, at 55, I routinely move pianos with no pain or soreness.

  • Chris Kinch

    Would you care to reference the articles you are getting this ‘research’ and ‘evidence’ from? These are heavy accusations and damning claims, which don’t actually have any referenced articles or cite where the information is coming from. If you are going to make such statements, you need to reference your material, otherwise you are dangerously misleading a large amount of people.

    • http://www.nightingale-collaboration.org/ Alan Henness

      You’ll find many of them discussed on his blog at edzardernst.com

      • Hesh

        A blog as a reference? Oh my stars! That’s completely credible! I see that he doesn’t have sources for his blog. Maybe he can use this article as a source while this article uses his blog as a source. That would be some airtight journalism right there!

        • http://www.nightingale-collaboration.org/ Alan Henness

          Oh dear.

        • Jem

          Calm down, dear. The point is that on his blog Prof Ernst supports his arguments with references to scientific papers. That’s because it’s his blog and he has control over it. as opposed to just a popular online news magazine which he has no control over.

          • Hesh

            That’s the point of accountability, if you are accountable to no one but yourself you will make whatever claims you wish and the naysayers will have their input deleted. I saw zero “peer reviewed journals” mentioned on the website and if he had any to reference they would be put behind a paywall which means there is no way to check his claims for accuracy.

          • Jem

            Speak for yourself. As I said, Edzard supports his claims with references to scientific papers – it’s not his fault if some of these are behind a paywall. They are there and accessible to anyone who cares enough. He doesn’t delete input from “naysayers” as the most cursory examination of comments will reveal.

          • Jem

            He links directly to his sources. It’s not his fault that some of them are behind a paywall – unfortunately a lot of peer reviewed journals are.

      • UKSteve

        Are you paid by the Speccie, or him?

        Why would you repeatedly cite a blog that people have torn holes in?

        • http://www.nightingale-collaboration.org/ Alan Henness

          LOL!

          • UKSteve

            The typical response of…. a juvenile.

          • http://www.nightingale-collaboration.org/ Alan Henness

            And what about your unevidenced insinuations of being paid, by whoever? Are you able to back them up yet?

          • UKSteve

            Proof already provided; your attention span is the problem.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Ah, you must mean chiropractic levels of ‘proof’?

          • Maria_Maclachlan

            No, he means homeopathic levels.

          • Jem

            If proof is already provided (which it isn’t, of course) why do you ask who paid him?

        • Jem

          Spitting the dummy over articles you don’t like ≠ tearing holes.

        • El_Trolldego

          Obvious troll is obvious.

          • UKSteve

            ???

  • Greg Lekas

    To say modern day chiropractic is ineffective and dangerous is to say modern day Neurology, Orthopedics, Physical Therapy, Immunology, Genetics, Nutrition, Obstetrics/Gynecology, Proctology, Urology, Hematology, and Radiology are ineffective and dangerous. Perhaps the author, and more importantly the “Peanut Gallery”, should read…(better yet, re-read) the following article. Then you will be able to see why older, under educated MD’s respond with such nonsense. By the way, Professor Edzard….what’s the old saying “Those who can’t do, teach”?

    http://www.nytimes.com/1987/08/29/us/us-judge-finds-medical-group-conspired-against-chiropractors.html

    • http://www.nightingale-collaboration.org/ Alan Henness

      What’s a 30-year-old article got to do with the evidence for chiropractic?

  • http://www.simplebackpain.com/ SARAH KEY

    Considering the huge numbers of patients who seek Chiropractic treatment, I think the figures cited here are small. I sense there is much greater damage caused by inappropriate surgical procedures for which there is very little scrutiny, accountability and recourse. As a physiotherapist myself, I have a great regard for Chiropractic – not least because by and large, for conditions that need manipulating, chiropractors have better skill than most physiotherapists. I believe this to be even more critical with the recent trend of Physiotherapy deeming it appropriate ‘not to touch the patients’ when managing their back pain, and simply to give them a list of exercises. Equally inappropriate is the notion that a patient’s brain is decides the pain and that they should not be focusing on their pain as much as they are. With Physiotherapy becoming less hands-on, it is falling more and more to the other hands-on professions such as Chiropractic and Osteopathy (even massage therapy) to take over with Physiotherapy is lapsing.
    Where I believe Chiropractic lets itself down is in not teaching their patients follow-up self treatment, in the way of mobilising and strengthening exercises (see http://www.simplebackpain.com) thereby not involving them in contributing to their spinal care and recovery themselves. Alas! All too often one hears of cases where patients are signed up for a year of treatment – bad practice in any area of Medicine

    • Mike Hall

      I’m not sure you can honestly make a sweeping statement like “by and large… chiropractors have better skill than most physiotherapists.” though from the first hand experiences detailed by some of the responders, I think that it is reasonable to assume that there are some very skilled professionals out there. Once again, it is a shame that the Scandanavian model is not used in Britain…

      Not touching patients is becoming a huge problem in many fields of medicine. My ex-girlfriend nearly died from endometriosis, which was easily diagnosed in minutes by a hands-on private gynaecologist in Lithuania; the NHS GP outright refusing to refer her for a scan due to the expense.

      I think you hit the nail on the head with your last sentence. I encountered one of these scam merchants who tried to sign me up to a year of unnecessary treatment, which discoloured the entire profession to me. Why would someone trying to make as much money as they can, try to involve patients in contributing to their recovery?

      In trying to protect the innocent from these jokers, we may well be missing an opportunity for an effective alternate treatment. Definitely, proper regulation and checks are needed urgently otherwise we will chiropractric treatment will continue to be thought of in the same way as homeopathy…

  • Kasmeister

    Stupidest thing I’ve ever read. I couldn’t swallow properly for 20 years
    & in a few treatments my chiropractor solves the problem! It literally changed my life.

  • ateo

    Chiropractors are complete bullshit. It isn’t biased if it is true. Just because a few idiots believe the magic doesn’t make it so.

    • norway campisi

      take a magic pill

      • Will_Z_Macht

        “Chemistry is magic.” – norway campisi, 2016

        • UKSteve

          Yeah I agree, and “Physics is f***ing awesome” – me, today.

    • UKSteve

      Your post is complete bullsh1t. What evidence have you for making such a juvenile assertion?

  • ateo

    You do know the entire profession was created by a fraud, right? Who gives a shit if it may be partially effective at treating mild lower back pain and NOTHING else? It is essentially useless until you have evidence otherwise.

    • swedelady13

      A chiropractor got rid of my occiptial headaches that I had had for years. Took only a few visits.

      • Colin55

        What did he actually do to you to relieve the pain?

    • John B

      By your logic, people should stop going to the barber.

      • Maria_Maclachlan

        You think hair-cutting was created by a fraud and is essentially useless?

        • John B

          A simple Google search on the history of barbers……oh never mind.

  • swedelady13

    A few hundred cases of death after visiting a chiropractor? Over a period of how many years? Was the death proven to be caused by the chiropractor’s work? People die after leaving their MD’s office too. My husband died from a hospital acquired infection. He went in due to symptoms traced to gastritis, which is minor. The CDC estimates approximately 65,000 people die each year in the US from hospital acquired infections…that’s in one year! This article is so lacking in facts and scientific evidence and is clearly biased.

    • http://www.nightingale-collaboration.org/ Alan Henness

      I see you didn’t understand Prof Ernst’s point about benefit-harm balance.

      • Troy Bratten

        Alan, you respond to a loving wife who lost her husband from a hospital acquired infection by criticizing her. That’s kind of low.

        • http://www.nightingale-collaboration.org/ Alan Henness

          My point had absolutely nothing to do with her tragic story but everything to do with the other things she said.

          • Troy Bratten

            My point exactly… These are real people you are responding to. Have some decency.

  • norway campisi

    give me a break the statistic for doctors mistakes and clients death and harming people for life are much much higher than a chiropractor …yes i believe in chiropractic!!! it works…. if their are some chiropractors trying to keep you coming back and you feel it is not necessary than don’t, but like in every profession including doctors they have loans to pay for the most part they are the closest to honestly caring about your health than yourself. T
    he testimony from clients speaks for itself .. I do not believe this article…… SUCK IT !

    • http://www.nightingale-collaboration.org/ Alan Henness

      norway campisi said:

      “the statistic for doctors mistakes and clients death and harming people for life are much much higher than a chiropractor”

      How does that change the evidence for the benefits and harms of chiropractic?

      • Ox-Bow

        What type of evidence will satisfy you to change your opinion Alan?

        • http://www.nightingale-collaboration.org/ Alan Henness

          That’s difficult to say. My opinion isn’t really important but I’m willing to look at whatever you think is the most compelling.

          If I’m right in assuming you believe chiro is safe and effective, what would convince you to change your mind?

          • Ox-Bow

            Here is an authoritative source from evidence based ODG (Official Disabilty Guidelines).http://www.odg-twc.com/odgtwc/low_back.htm
            There are links to the peer reviewed studies within the page:

            Current research: A recent comprehensive meta-analysis of all clinical trials of manipulation has concluded that there was good evidence for its use in acute, sub-acute, and chronic low back pain, while the evidence for use in radiculopathy was not as strong, but still positive. (Lawrence, 2008) A Delphi consensus study based on this meta-analysis has made some recommendations regarding chiropractic treatment frequency and duration. They recommend an initial trial of 6-12 visits over a 2-4 week period, and, at the midway point as well as at the end of the trial, there should be a formal assessment whether the treatment is continuing to produce satisfactory clinical gains. If the criteria to support continuing chiropractic care (substantive, measurable functional gains with remaining functional deficits) have been achieved, a follow-up course of treatment may be indicated consisting of another 4-12 visits over a 2-4 week period. According to the study, “One of the goals of any treatment plan should be to reduce the frequency of treatments to the point where maximum therapeutic benefit continues to be achieved while encouraging more active self-therapy, such as independent strengthening and range of motion exercises, and rehabilitative exercises. Patients also need to be encouraged to return to usual activity levels despite residual pain, as well as to avoid catastrophizing and overdependence on physicians, including doctors of chiropractic.” (Globe, 2008) These recommendations are consistent with the recommendations in ODG, which suggest a trial of 6 visits, and then 12 more visits (for a total of 18) based on the results of the trial, except that the Delphi recommendations in effect incorporate two trials, with a total of up to 12 trial visits with a re-evaluation in the middle, before also continuing up to 12 more visits (for a total of up to 24). Payors may want to consider this option for patients showing continuing improvement, based on documentation at two points during the course of therapy, allowing 24 visits in total, especially if the documentation of improvement has shown that the patient has achieved or maintained RTW. This systematic review concluded that there is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy, but there is no evidence for the treatment of thoracic radiculopathy. (Leininger, 2011) Based on high-quality evidence in adults with chronic low back pain, SMT vs other interventions has a small statistically significant, but not clinically relevant, short-term effect on pain relief and functional status, and referral for SMT should be based on cost considerations and patient and provider preferences. (Rubinstein, 2011) A NASS systematic review suggested that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function compared with other commonly used interventions. (Dagenais, 2010) All three interventions (manipulation, supervised exercise, and home exercise) had good outcomes in this RCT, but supervised exercise had a slight edge. (Bronfort, 2011) This RCT assessed the efficacy of spinal manipulation/mobilization (manual therapy) followed by specific active exercises and concluded that manual therapy accelerates reduced disability compared to exercise alone. (Balthazard, 2012) Osteopathic manual therapy (OMT) did well in this RCT. With 6 treatment sessions during a course of 8 weeks, 50% of the OMT group and 35% of the sham OMT group reported substantial improvement (relative risk [RR], 1.41). (Licciardone, 2013) According to this systematic review, there is a paucity of quality clinical trials testing osteopathic manual therapy in adult patients with chronic non-specific low back pain, and more data is required. (Orrock, 2013) In patients with back-related leg pain, spinal manipulative therapy (SMT) plus home exercise and advice (HEA) provided more short-term improvement in pain and function than HEA alone. SMT plus HEA demonstrated a clinically significant advantage over HEA after 12 weeks, but not at 52 weeks. At 12 weeks, 37% of patients receiving SMT plus HEA had at least a 75% reduction in leg pain, compared with 19% in the HEA group. (Bronfort, 2014) The AHRQ draft comparative effectiveness review of noninvasive treatments for low back pain concluded that spinal manipulation was no more effective than sham manipulation, but manipulation was as effective as other interventions thought to be effective. (AHRQ, 2015)

          • UKSteve

            Great post!

          • Ox-Bow

            Would any of the scientific evidence below satisfy you Alan?

        • UKSteve

          Do you know he even down-voted this post of yours?

          A truly pathetic individual:

          http://www.nightingale-collaboration.org/

          • http://www.nightingale-collaboration.org/ Alan Henness

            You’re still complaining about who up or down-votes different comments! That’s hilarious!

          • UKSteve

            No. Pointing out the fact that you are a very sad and pathetic empty vessel, with absolutely no idea of how do carry out adult discussion.

            Someone asks “What type of evidence will satisfy you to change your opinion?” – and you down vote them. As I said….pathetic.

          • http://www.nightingale-collaboration.org/ Alan Henness

            This is a fascinating meta-discussion, isn’t it – thanks for your opinion on up and down-voting.

          • UKSteve

            Apart from your attention span deficit (see above), you don’t have anything to say on anything else, judging by your posts, other than being a clueless Ernst-obsessive.

          • Ox-Bow

            I’d like to hear your response to the overwhelming scientific evidence that chiropractic and manipulation is a beneficial choice for musculoskelatal issues, Alan. Here is more:

            Medical evidence shows good outcomes from the use of manipulation in acute low back pain without radiculopathy (but also not necessarily any better than outcomes from other recommended treatments). If manipulation has not resulted in functional improvement in the first one or two weeks, it should be stopped and the patient reevaluated. For patients with chronic low back pain, manipulation may be safe and outcomes may be good, but the studies are not quite as convincing. While not proven by multiple high quality studies, a trial of manipulation for patients with radiculopathy may also be an option, when radiculopathy is not progressive, and studies support its safety. As with any conservative intervention in the absence of definitive high quality evidence, careful attention to patient response to treatment is critical. Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly work. Potential cautions or contraindications include coagulopathy, fracture, and progressive neurologic deficit. (Andersson-NEJM, 1999) (Cherkin-NEJM, 1998) (Mohseni, 1998) (Aure, 2003) (Pengel, 2002) (Assendelft-Annals, 2003) (Assendelft-Cochrane, 2003) (Cherkin-Annals, 2003) (Licciardone, 2003) (Giles, 2003) (Ferreira, 2003) (Assendelft-Cochrane, 2004) (Grunnesjo, 2004) (Bronfort, 2004) (Hoiriis, 2004) (Oliphant, 2004) (Koes, 2004) (Legorreta, 2004) (UK BEAM, 2004) (Ianuzzi, 2005) (Muller, 2005) (Licciardone, 2005) (Airaksinen, 2006) (Ernst, 2006) (Hurwitz, 2006) (Santilli, 2006)

            One high-quality clinical trial comparing chiropractic and physical therapy found both effective, but chiropractic was slightly more favorable for acute back pain and PT for chronic cases. (Skargren, 1998) An economic evaluation of four treatments for low-back pain (excluding pharmaceuticals) concluded that mean costs per treatment group were $369 for medical care only, $560 for chiropractic care only, $579 for chiropractic care with physical modalities, and $760 for medical care with physical therapy. This study did not compare outcome success. (Kominski, 2005) Physician consultation is more cost-effective alone than when combined with manipulative treatment; outcomes show significant improvement in both groups, but the combination group had slightly more reduction in pain and clearly higher patient satisfaction. (Niemisto, 2005) Various techniques of manipulation are done by different providers. Manipulation, as used in the above studies, is defined as a process of physiological movement which goes beyond the passive range of motion into the paraphysiological zone, which may involve high velocity with or without recoil. This form of manipulation (“diversified”) is the most commonly used by chiropractors; there is another form (“flexion-distraction”), but there are limited studies. The efficacy of distraction manipulation is not well established. (Gay, 2005) Spinal manipulation has been reviewed in 4 good-quality systematic reviews, and short-term, but not long-term, improvements have been reported. (Kinkade, 2007) Patients with acute low back pain receiving recommended first-line care did not recover more quickly with the addition of diclofenac or spinal manipulative therapy, according to the results of a randomized controlled trial in the November 8 issue of The Lancet. (Hancock, 2007) In this study of workers’ comp patients, less chiropractic care visits was significantly associated with a lower likelihood of disability recurrence and 8.6% shorter disability duration. (Wasiak, 2007) A recent RCT found pain reductions were similar in both the experimental and control groups. Outcomes were assessed daily on days 1 to 14 by patient diary and at 6 months by mailed questionnaire. Limitations of the study included inability to closely monitor patient diaries, low recruitment rate, inability to blind clinicians and patients to treatment, and use of equivalence doses as the primary outcome measure. (Jüni, 2008)

            Number of Visits: Several studies of manipulation have looked at duration of treatment, and they generally showed measured improvement within the first few weeks or 3-6 visits of chiropractic treatment, although improvement tapered off after the initial sessions. If chiropractic treatment is going to be effective, there should be some outward sign of subjective or objective improvement within the first 6 visits. These findings question the need for extended treatment, or at least encourage the need for reassessment after a few weeks of treatment. (Burton, 2000) (Hurwitz, 2002) (MD Consult, 2003) (Stig, 2001) (Niemsto, 2003) (Haas, 2004) (Haas2, 2004) (Descarreaux, 2004) One specific study showed a success rate of 88% by six weeks with an average total of 8.2 visits, and 3.8 more if recurrence. (Triano, 1992) Another clinical trial found that only 4 sessions of manipulation and stabilizing exercises resulted in less pain and disability than physician consultation alone. (Niemsto, 2003) An RCT to determine the optimal number of visits for spinal manipulation found that either 12 or 18 are best, depending on time frame, with 18 best after a year. One hundred patients with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor, three times per week for up to 6 weeks. At 12 weeks, the greatest differences from the no-manipulation control were found for 12 visits, but at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits. They concluded that the number of spinal manipulation visits had modest effects on outcomes over those of 18 hands-on visits to a chiropractor, but overall, 12 visits yielded the best return, but that was not well distinguished from other dose levels. (Haas, 2013)

            Patient Selection Criteria: The results of a recent study demonstrate that two factors – symptom duration of less than 16 days, and no symptoms extending distal to the knee – were associated with a very good outcome from early referral for spinal manipulation. After only 1-2 sessions of spinal manipulation treatment and a range of motion exercise, the success rate when both criteria were present was 85%, and when both criteria absent was only 28%. (Fritz, 2005) Other studies support using patient selection criteria, including: (1) Duration of current LBP less than 16 days; (2) Not having symptoms below the knee; (3) FABQ score less than 19 points; (4) At least one hypomobile segment in the lumbar spine; & (5) Hip internal rotation range of motion >35 degrees. (Flynn, 2002) (Niemisto, 2004) (Fritz, 2004) (Childs, 2004) (Riipinen, 2005) Patients with signs and symptoms that suggest movement restrictions of the lumbar region should be treated with joint mobilization–manipulation techniques and range of motion exercises. (Fritz-Spine, 2003)

            Active Treatment versus Passive Modalities: Manipulation is a passive treatment, but many chiropractors also perform active treatments, and these recommendations are covered under Physical therapy (PT), as well as Education and Exercise. The use of active treatments instead of passive modalities is associated with substantially better clinical outcomes. (Fritz, 2007) Active treatments also allow for fading of treatment frequency along with active self-directed home PT, so that less visits would be required in uncomplicated cases.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Not sure why you’re interested in my opinion. Perhaps you’d be better making sure Prof Ernst is aware of this evidence?

            Anyway, if there is all this good evidence, why does NICE only suggest ‘manipulation’ (not even specifically chiropractic) for LBP?

          • Ox-Bow

            Would you explain the difference between manipulation and chiropractic?

          • http://www.nightingale-collaboration.org/ Alan Henness

            You’re asking the wrong person. I’ve asked many chiros in what ways a chiropractic manipulation differs from one carried out by an osteo or a physio, but have never received a cogent answer. Do you know the difference?

          • Ox-Bow

            Chiropractors receive far more hours of training and experience in physical manipulation techniques than osteo’s and physio’s Thus, chiros are the experts in the particular field. They also receive more training in Radiology than the two and more than a GP MD. Chiro’s receive more diagnostic hours than a physio, and an equal number of hours on biomechanics. Hand placement, leverage, angle of the HVLA is more technical with a trained chiro. For instance, every chiro knows not to put the cervical spine in extension in a manipulation, but many of Ernst’s cited studies are flawed in that they do not address the specifics of how “manipulation” is done, nor what type of provider is manipulating the spine. So, to answer your question, the difference lies with the better trained and experienced professional.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Ox-bow said:

            “Hand placement, leverage, angle of the HVLA is more technical with a trained chiro.”

            Any parameters for those and for the manipulations done by an osteo or physio so we can see the difference? What about the velocity and amplitude?

          • Ox-Bow

            What do you specifically mean by parameters? The initial and bulk of chiropractic education regarding the subject of maipulation invlolves biomechanics,position of the patient, angle of thrust, etc. As far as velocity and amplitude, that comes only with deft experience. The last year and a half of a chiropractor’s education is in a school clinical setting attempting to provide as much experience as possible. Although not comparable to rounds in a medical setting, there are requirements that must be met on these manipulations that are overseen by an experienced clinic director/staff.

          • http://www.nightingale-collaboration.org/ Alan Henness

            You mentioned hand placement, leverage and angle. HVLAs involve velocity and amplitude. These are presumably all measurable and differ between what chiros, osteos and physios do, so what parameters (values) correspond to each?

          • Ox-Bow

            I’m not aware of any studies regarding inter-examiner differences, are you? I would like to see that. It would present an interesting study to have, say, 3 separate groups of equally experienced chiros, osteos, and physio’s treat a controlled population with equal levels of low back pain and analyze the data. But until that study is funded and performed, I would stick with the profession that has the most experience in the matter. Indecently, I don’t know about the UK, but multidisciplinay care is gaining popularity in the US. Believe it or not, many chiros, osteos, and physios refer within each other according to there strengths of expertise. Chiros with passive therapies (including manipulation), physios with active care, and Osteos for medication managment as they appear more conscious about over prescribing opiods and narcotics. A multidisciplinary approach provides for an effective and less costly approach to complicated musculoskelatal issues.

          • http://www.nightingale-collaboration.org/ Alan Henness

            So you don’t know what it is that differentiates a chiro form an osteo or a physio? Yet they all claim to be different. How is anyone meant to know which is which and what they’re getting? By the brass name plate? But we have three different statutory regulators for them in the UK, yet there might not be anything that separates them. That seems like a bizarre situation, don’t you agree?

            Perhaps chiros and osteos should fund a study to find out if they are different and merge if they are not? Then they could fund some high quality studies to find out whether their manipulations are, indeed, effective? And if not, disband.

          • Ox-Bow

            Ahh, Are you proposing that the public better educate themselves on modern approaches healthcare? I could not agree more! But I see no need to merge. There are plenty of patients available for all professions.

          • http://www.nightingale-collaboration.org/ Alan Henness

            Nope. Can you answer my question about what is it that differentiates a chiro manipulations from the others?

          • Ox-Bow

            I thought I did. Training and experience. More hours of education etc…..

          • http://www.nightingale-collaboration.org/ Alan Henness

            Thanks for that. I’m not sure osteos or physios would agree with you, though.

          • Ox-Bow

            In conversations I have had they do. Chiros for passive, physios for active, and osteos for med mgmt with overlay of training between the 3.

          • http://www.nightingale-collaboration.org/ Alan Henness

            That raises the question as to how someone would know which one to go to. However, I’ve had physio that was both active and passive, so I’m not sure there are clear distinctions on that either.

            But that all just brings us back to the same question.

  • Seabreezes1

    Don’t go if you don’t want to. But for me, I prefer an occasional visit when my back is bothering me that immediately eliminates the pain to popping pills every day to mask the pain. What’s more, it is much safer. See US statistics on medical deaths and harm: http://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals

  • Tarek

    So either millions of patients are full of crap and out of their minds when they say that they have benefited from chiropractors, or 1 individual really needs to back up his claims with at least references to a few papers anyone can appraise.

    As a doctor, I think i’ll listen to the “million mad people”.

  • Truth Be Told

    I am extremely skeptical of Mr. Ernst and his preposterous claims. Seems that he also claims that alternative medicine, homeopathy in particular, made the Nazis commit their horrible atrocities during WWII. Ex-pat Herr Ernst is very serious about this. He actually very publicly posted it on his “blog”:

    http://edzardernst.com/2013/01/the-holocaust-and-nazi-alternative-medicine/

    It seems that he would like to rid the world of all very popular and well accepted, safer non-drug approaches to health care once and for all.

    • http://www.nightingale-collaboration.org/ Alan Henness

      Where, exactly, does Prof Ernst say that “alternative medicine, homeopathy in particular, made the Nazis commit their horrible atrocities during WWII”?

      • Truth Be Told

        Oh, haven’t you read Mr. Ernst’s blog post on this topic?
        “It is well-documented that alternative medicine was strongly supported by the Nazis. The general belief is that this had nothing to do with the sickening atrocities of this period. I believe that this assumption is not entirely correct.”

        There are more statements that he supports this view. You may want to familiarize yourself with this. It is really quite an unbelievable position to take.

        • Maria_Maclachlan

          Oh, don’t be ridiculous! He doesn’t say that alternative medicine MADE the Nazis commit atrocities, what he is saying – and he makes this quite clear in the relevant article – is that the Nazis had ideologically and politically expedient reasons for supporting alternative medicine at the time. He is making a nuanced argument that you are totally failing to comprehend and the fuss you are making beggars belief.

  • Bob Minor

    How about an article on the misdiagnoses, prescription mistakes, and treatment mistakes of MDs.

    • http://www.nightingale-collaboration.org/ Alan Henness

      That would be good to read (but irrelevant to this discussion), but, as Prof Ernst himself has said, that is not his area of expertise, so someone else would need to write it. Perhaps you could?

  • Poohdhdh Mandwsklfjhwe

    Pain killers, physical therapy, and surgery did not work for my pain in my back cause by herniated discs but the chiropractor sure did i will always go to one if i am in pain. Cortisone shots worked for a few days but it usually hurt worse then before after it wore off.

  • Gord Bestwick

    I’ve always been under the personal belief that chiropractic care has a very narrow and specific region of ailments that it can treat, and when it is used for those purposes then it can be an effective option.

    I will freely admit to confirmation bias and using anecdotal evidence on this. I’ve seen about 10 different chiropractors in my life and I can confirm that this is not a consistently applied field. My latest chiropractor is what I’d call a “Practical Application” chiropractor.

    He bases his treatments like this: You are feeling bad at spot X,Y,Z,X1,Y1,Y2,etc. You are feeling pain because this muscle is inflamed, which is causing X. I am going to remediate this by providing precision massage and a manipulation to this end. And more importantly, he says it will take X days and Y treatments. (Of which are quite low compared to normally what I hear) And in X days and Y (+/-1) treatments the ailments are managed as promised.

    He explanations and treatments are based upon sound concepts, repeatable methodologies and testable postulations.

    Never once has he claimed that he could provide relief on except skeletal-mechanical related issues. He shows outward disdain for Woo-related claims. Even into the field of nutrition he recommends a balanced diet, lots of vegetables. (Although he really does like Quinoa, so a point off of him for that…. :-D )

    Now, it should be noted that he works at an office specializing in post accident physiotherapy. So, he is in an environment that is results based.

    My sentiments are that if this was the methodology and goals of chiropractic care as a whole, then the field would be more effective and filled with less froo-froo.

  • Diana Buckley

    As with all professions, there are good and bad. I have to say ” horses for courses” and general poo pooing medicine has not put right for me , what chiropractic has.

    • Truth Be Told

      Funny, my Google translator lists every language but yours. It can’t seem to translate what you wrote into English.

      • Jem

        If you’d realized she’s on your side, would you still have been so rude?

        • Truth Be Told

          No, of course not. Didn’t think I was being rude. Actually, I was trying to be funny. You have to admit she sounds a little like Yoda. ;-)

  • Mike E

    It based on quasi science and personal opinions are without value. If personal opinions were taken as facts then we should belive in witches, trolls and astrology.
    It might have a “massage” value, but anything else is nonsense.

    • Truth Be Told

      Quasi science? Personal opinions? I think you are referring to psychiatry.

    • UKSteve

      You posts consist of words formed into sentences, but they are still utter nonsense.

    • disqus

      How on earth did the the world evolve and scientific and medical scientific thinking, philosophy and theology or any other belief systems ever develop if personal opinions are without value?

  • Dewbert

    There’s side effects, injury, or death potential in ALL medical treatment. If the true frequency of such tragedies in chiropracty is unknown, it’s because the health industry doesn’t track it because they refuse to acknowledge that chiropracty could be a legitimate, effective form of treatment.

    I have had success with a chiropractor — to an extent. It made my neck pain worse. It freaked me out and I had him stop working on my neck. He fixes my lower back pain when it is more painful than normal. Once he gets me to my normal level of pain, I stop going until the next time when the pain is more intense than normal. Chiropracty doesn’t cure the problem. It is like an effective form of temporary pain relief. Just like pain relief pills, except more effective than any pain relief pill I have taken. Those pills have done absolutely nothing for me, except given me side effects, like making me tired and dizzy-brained and, even, mangling my gastrointestinal system, which could actually kill me.

    A person I know had the medically-sanctioned needle in the back. It made things worse. Two people I know have had back surgery. It worked on one of them. The other is considering more back surgery. Why? It probably won’t work and it could kill him.

    So, why does the medical elite think it’s OK for their ineffective treatment with side effects, but not OK for fairly effective chiropractic treatment with side effects?

    I imagine that 30 deaths after chiropractic is nothing compared to the deaths after other “sanctioned” medical treatment.

    The informed consent from patients before starting therapy is a medical practice, as well. It’s so you don’t sue your doctor, if they kill you. No one has ever verbally explained it to me — not a doctor, nor a dentist, nor a chiropractor.

    I was suspect of chiropracty, myself, until I went to a chiropractor and it actually helped. Don’t knock it until you’ve tried it.

  • TheEdgeLord

    Chiropractic is a religious cult.

    • UKSteve

      Stupidity is an encumbrance.

      • Maria_Maclachlan

        You should know.

        • UKSteve

          What an incredibly childish response.

          What the Hell is wrong with you pair of wierdos?

          • Maria_Maclachlan

            Nothing – just responding to your incredibly childish comments in the only manner you seem to understand. You bring nothing to the table here but childish insults so maybe it’s time you grew up and learned to take what you keep dishing out?

          • UKSteve

            As I say, incredibly childish. Go away, troll.

          • Maria_Maclachlan

            Yawn. Change the record, moron.

          • UKSteve

            Get a life, window-licking looney.

  • Frank Blunt

    Medical industry deaths …

    – infections caught from
    being in a hospital –

    deaths yearly = 75,000

    http://www.cdc.gov/HAI/surveillance/

    http://www.cdc.gov/washington/~cdcatWork/pdf/infections.pdf

    “”” 1-in-25 gets infected in a hospital”””
    http://www.cnn.com/2014/03/26/health/hospital-infections/

    ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

    – deaths caused by doctors
    making errors with meds –

    “””Medication errors cause at least one death every day and injure approximately 1.3 million people annually”””

    http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm

    ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

    “””approximately 200,000 Americans die from preventable medical errors”””

    http://www.ncbi.nlm.nih.gov/pubmed/23155743

    ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

    firemen FAIL to save about 3,000
    people yearly !!!
    and they FAIL to prevent about
    17,500 injuries per year…
    where is the conversation about
    holding them accountable ?

    https://www.usfa.fema.gov/data/statistics/

  • Frank Blunt

    in sept of 2013, a 1973 tooth crown fell off and the next day my liver was shutting down. apparently I received mercury poisoning…
    let’s see,,, chiropractic injuries yearly vs, medical errors and hospital-caused infections deaths… hmmm… apparently I statistically have a much better chance of survival with chiropractic…
    the blood test guys said it would be a year plus getting the 44 liver enzymes back into the zone. it only took us 5 months…
    should I have checked into a hospital and faced the 1-in-25 odds of catching an extra disease or two ? or becoming one of the quarter million killed by preventable medical errors ? I think not.
    but it’s your life… roll the dice where ever you like. personally, I’d check the statistics first.

  • Russ

    The dilemma is that in the US for instance; over 100,000 people die each year from their MD’s mistakes, mis diagnosis or malpractice. So, who do you believe?

  • Truth Be Told

    Deaths from preventable medical errors, not those who were so sick that they were going to die anyway, are the leading killers of both Americans and Brits each year. More people die EACH YEAR in the U.S. from preventable medical errors than have died in all the wars the U.S. has been involved in…combined.

    http://www.lifeextension.com/magazine/2004/3/awsi_death/Page-01

  • Mike Wheels

    provide your sources and I might have finished reading the article….otherwise I will file this under “internet jibberish”. And I’m a physio…

    • Truth Be Told

      My sources? It is a scholarly paper. Had you finished the article, or at least skipped to the last page, you will find these author’s (MDs/PhDs) sources/references. 152 of them from peer-reviewed journals and public health records. Didn’t they teach you in fizzeo school to look at the end of a paper for sources?

      • Maria_Maclachlan

        What makes you think he was talking to you?

        • Truth Be Told

          I don’t know. I thought he was talking to me. If not, sorry about that.

  • funkydow

    Was this paid for by the pharmaceutical industry? You know, the ones who make the drugs that are the leading cause of death in the US after heart attack and stroke? They certainly have an enormous financial interest in keeping us addicted to their pain meds rather than using drug-free solutions like chiropractic. Oh, and my personal interest in this is that I’ve used chripractors to treat pain caused by a spinal deformity 40 years without any problems — and without using drugs. OR surgery. So someone died in Jakarta, that’s a tragedy; but thousands are dying each year from the prescribed use of pain medications, taken as directed. It’s your health and your life, you decide.

    • Maria_Maclachlan

      Is the Spectator owned by a pharmaceutical company? No, I don’t think so.

  • Truth Be Told

    Hi Al Henness, here are more of the references that you asked for regarding Mr. Ernst’s bizarre view that natural health care made the Nazis commit atrocities. Not sure how you missed all this. Perhaps you support these views, too?

    ‘It is well-documented that alternative medicine was strongly supported by the Nazis. The general belief is that this had nothing to do with the sickening atrocities of this period. I believe that this assumption is not entirely correct”

    “By contrast, there is almost no published evidence that these activities included in any way alternative medicine, and the general opinion seems to be that there are no connections whatsoever. I fear that this notion might be erroneous.”

    “As far as I can make out, no systematic study of the subject has so far been published, but I found several hints and indications that the criminal experiments of Nazi doctors also involved alternative medicine.”

    “Dr Wagner, the chief medical officer of the Nazis was a dedicated and most active proponent of alternative medicine.”

    “Dr Madaus (founder of the still existing company for natural medicines by the same name) experimented on the sterilisation of humans with herbal and homeopathic remedies, a project that was deemed of great importance for controlling the predicted population growth in the East of the expanding Reich.”

    In my view, Herr Ernst’s views are insulting. Anyone else find this insulting?

    http://edzardernst.com/2013/01/the-holocaust-and-nazi-alternative-medicine/

    • Maria_Maclachlan

      I don’t. Why are you taking it personally?

    • Jem

      How is pointing out that a bunch of Nazis did vile experiments using herbs and homeopathy insulting to you?

  • http://ayashaman.co.uk/ Marcela CF Saiffe

    I had a severe scoliosis and torsion of my spine, product of a nearly fatal highway accident. I went to my Chiropractor that looked at the x-ray studies and after over a dozen visits for therapy, my spine was straight again, with only a vertebrae slightly twisted. That was in Mexico, with a Disciple of Farlow (a renowned USA Chiropractor). I’m still looking for a good Chiro in UK, so thanks to this article for letting me know they have a good school here. I wouldn’t have never considered the orthodox medicine solution (a very risky surgery at a skyrocketed price) over my Chiropractor treatment. I can walk without pain and I can bend to touch the floor with my hands again. A good Chrisopractor perhaps is not common, but having located one, is a truly blessing. It’s easy to write a critic when you have not experienced being so badly treated by orthodox medicine, and without having the wonderful experience of having regained your life thanks to alternative methods.

  • http://ardentreflections.com/ Vicki Maheu

    All I can say to this is that I was in pain for a year. I had to stop exercising, I hurt no matter what position I was in, standing, sitting, lying down…

    The chiropractor adjusted my sacroiliac joint and the pain was gone, instantly. All regular medical doctors offered me was narcotics, none of which I can take other than morphine…

    I’ll add though, that after some research, I decided to tell him not to adjust my neck.

  • referencegirl

    This looks like confirmation bias. The author has a prejudice against chiropractors so he has cherry picked the evidence against them. There is an obvious bias towards allopathic medicine. The author referees to some system in place that monitors all adverse events of conventional treatments which isn’t true.

    • Maria_Maclachlan

      Rubbish. His natural bias was towards CAM but the more he investigated these scientifically the more they were revealed to be a crock.

  • Troy Bratten

    Manual therapy stands to science and is one of the most effective and cost efficient remedies for maladies concerning the NMS system. Whether it is osteopathic therapy, physical therapy, massage therapy, occupational therapy, physiatry, or chiropractic therapy – the common theme of manual therapy is effective and heavily supported by peer reviewed journals in the United States. Chiropractic therapy differs from other manual therapies mostly in its use of high velocity low amplitude thrusts, which other manual disciplines do not currently do, but are starting to adopt and deem therapeutic, i.e. the doctorate in physical therapy degree (United States) now teaches this technique with the associated “cavitation” or “popping” sound that one hears with a manual therapy adjustment performed by Osteopathic or Chiropractic Physicians.

    It is thoroughly understood, based on well-performed systematic reviews and meta-analyses done in recent years that chiropractic therapy is safe and effective, and this is especially true within the realm of NMS pain (radicular and scleratogenous) of the neck and low back.

    Please, stop trolling on these comments and go delve into the scientific literature. There is surmounting evidence for manual therapy, including CMT; you just look awkwardly out-of-the-loop if you state otherwise. And put the whole stroke myth to bed. Johns Hopkins, an evidence based American medical school, did – you’re opinion does not trump sound science.

    • Maria_Maclachlan

      “go delve into the scientific literature.”

      OK.

      https://www.sciencebasedmedicine.org/top-10-chiropractic-studies-of-2013/

      • Troy Bratten

        When you feel emotionally negative towards something, as I’m implying you do, it is easy to nitpick. 10 studies from 2013, awesome. I’m sure that really signifies a lot.

        • Maria_Maclachlan

          Really? What do you think it signifies?

  • Troy Bratten

    The Chiropractic Research Agenda (CRA) was enacted in 1996. Since then, and especially as of the past few years, a flurry of well-performed research studies have been done. So, if you are an out-dated health care professional you will be way out of the loop!

  • http://www.RecoveryHealthCare.me/ Dr. Herby Bell

    Edzard, Properly prescribed medications and medical procedures are the 3rd leading cause of death in the United States. How about cleaning up your own, pernicious profession? You can not be serious, (Strong McEnroe emphasis)? Physician heal thyself.

  • Omar

    Out of those 30 cases only about half were ADJUSTMENTS performed by a Doctor of Chiropractic. In several cases the DC was blamed when the person had a stroke WEEKS LATER. Im sorry but the title of your article and the majority of content is based on erred or even intentionally biased research.

  • Omar

    Let’s not also forget to take a look at malpractice insurance rates. Based on the insurance companies rates, Chiropractic is by far safer than medical care. I believe it’s about 1/10th the cost vs that of a medical Dr.

  • John T. Cece

    Hard to believe article like this still exist. The most respected scientific journal on the topic of the spine is “Spine”. This journal only deals in cold, hard scientific literature. It has a paper rejection rate of 87% the highest of any research journal. They concluded that the incidence of arterial injury is so low that a patient has a better chance of the chiropractic doctor dropping dead during treatment than the patient has. If this isn’t enough for you, consider cold hard cash…in the USA, many chiropractic doctor’s pay less in premiums for malpractice than they do for their auto insurance! Again, the numbers don’t lie. Oh, and speaking of the deaths caused by doctors, in the USA, there are approx. 400,000 preventable deaths per year making the medical errors the 3rd leading killer in the country after heart disease and cancer.

  • doc

    The implied, hidden meaning is that, due to harmful chiropractic effects, medicine is better. The AMA says that properly prescribed medicine, taken properly, is the #3 cause of death in the USA. True, some forms of chiropractic are brutal and, in my opinion, should be eliminated, but modern medicine??? Look at the FACTS. Most surgeries are unnecessary, and NO drugs cure, but Americans are totally brainwashed into thinking that because their doctor recommends them, they’re “good” for them. “First do no harm?” HA! What medicine DOESN’T do harm (before it can have any positive effects)?

  • Greg Lekas
  • Melissa Briscoe Lamarche

    Here is a peer reviewed article that shows no causation between the Chiropractic Adjustment and cervical artery dissection. Medical Doctors have no evidence to back up their own opinions about the power of the Chiropractic Adjustment. This guy is ignorant. http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation#.V0MNxQSUG-g.twitter

  • CommentTeleView

    The link between CAD (cervical artery dissection) and chiropractic has been thoroughly debunked (http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation ), and the author should be ashamed of himself for resorting to scare-mongering.

  • Soledad

    I have been seeing a chiropractor for the last two weeks. I went to him due to lower back pain radiating down my buttocks, neck pain, and numbness and tingling in the upper left part of my back causing a cold, crawling feeling. He took x-rays of my neck and lower back. My neck showed I have arthritis. He said he took the one of my lower back to determine if there were any breaks or tumors. There weren’t any. But, since I’ve been seeing him and he’s been using electrodes on my back, then manipulating my spine, I’ve not felt better, I’ve actually felt worse. I have felt more pain in my lower back and I’m taking arthritis medication for that. It helps some. I still have the numbness, and have experienced even more in my arm and am now having chest pains. I haven’t felt good since I starting going there. I don’t know if it’s all coincidence.