The latest Cochrane review indicates that chiropractors do as well as conventional treatment for lower back pain.
It’s not clear from the summary whether the control interventions were conventional best practice or not. The authors also noted most of the trials had high risk of bias.
It’s quite easy to do objective science based on X-rays. The moment where you diagnose based on subjective perception it becomes harder to do science.
Actually it should be quite easy to do science by comparing chiropractors’ diagnostic accuracy to diagnoses done by radiologists. If you can see it on an x-ray in superficial anatomy a chiropractor should definitely feel it. Also if there’s anything wrong with the positions of vertebrae that a chiropractor can feel an MRI would definitely show it. Do such trials exist?
Doctors do diagnostics manually too. The difference is they won’t tell you their subjective methods are out of the reach of science. Same goes for physical therapists, wonder why big pharma isn’t lobbying against them...
Actually it should be quite easy to do science by comparing chiropractors’ diagnostic accuracy to diagnoses done by radiologists.
If it’s about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn’t necessarily show any evidence.
An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.
Same goes for physical therapists, wonder why big pharma isn’t lobbying against them...
I know very little about how how societal attitudes about physical therapists formed and who’s responsible for it but I wouldn’t be very surprised if there isn’t someone on the payroll of big pharma out there who’s job it is to lobby for stronger standards of evidence for studies for interventions of physical therapists.
In practice many physical therapists also do a lot of things that aren’t backed up by studies that show that they work for a specific condition.
If it’s about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn’t necessarily show any evidence.
Point is if they can’t notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn’t avoid science even in this area.
An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.
fMRI is a dynamic modality for imaging the brain which has nothing to do with what we’re talking about. I was suggesting plain MRI, which is actually renowned for its accuracy in imaging soft tissues and not only bones.
In practice many physical therapists also do a lot of things that aren’t backed up by studies that show that they work for a specific condition.
Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.
Point is if they can’t notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn’t avoid science even in this area.
One approach is to say: “Hey, this location feels off. If I do technique X this location doesn’t feel off anymore and the person feels better. They aren’t in pain anymore and their symptoms disappear.”
It’s another problem to figure out the underlying biology and be able to say exactly what’s happening. That takes certain skills that usually don’t go hand in hand with being able to perceive locations that are off.
It’s also next to impossible to get funding for that kind of research. I know someone who does her PHD at using the kinect to do computer modeling of an proven physical intervention used by some physical therapists. There’s little grand money available for that kind of research. Most of the grant money goes to cell biology and biochemistry. Universities have to seek external funding these days and big pharma has money to throw around. Some science that is in principle doable isn’t done because there nobody to fund it.
Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.
I do think that risk of interventions is a concern but I don’t think it’s the driving force for mainstream beliefs about chiropractors. Given the inherent risk, it makes more sense to start with lower risk interventions.
As far as potential harm from interventions from physical therapists the risk is likely less, but I would be surprised if there’s no physical therapists that messed someone up.
Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.
What are your suggestions for how to most reliably evaluate anecdotal data? Would it be possible to do some sort of meta-science on this topic? How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)
I understand many medical treatments aren’t RCT based either but the fact that many are kind of makes me trust the mindset of health care professionals more.
Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.
And indeed it turns out they are: this is a pretty standard part of the alternative medicine anti-rationalist toolkit.
I haven’t made a simply argument against doing science in principle. I made arguments that you shouldn’t assume that everything there is to know is discovered by science_2014.
How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)
Hypnosis is basically about utilizing suggestion in efficient ways. If you do it right then you can switch off any pain with it.
How can argue that this is basically placebo but that doesn’t change anything about the fact that the person isn’t in pain anymore and the person wouldn’t get the same effect if they would go to a person who’s not skilled at using suggestion.
Furthermore any somatic intervention by definition targets someone’s subjective experience. The notion of placebo’s doesn’t make any sense for somatics.
Instead of testing against placebo I would prefer testing against the Gold standard for treatment. A person who’s in ill cares whether he gets healed better by treatment A or by treatment B. He doesn’t care about placebos.
In some cases you can run additional trials with placebos to get additional knowledge, but comparison to Gold standards seems more important to me.
Of course it’s good for big pharma to have placebo blinding as the default standard. That way there less pressure to show that new drugs outperform old ones and treatments that aren’t blinded as easily because they aren’t pills or injections get shun.
I also think that the system that Eliezer proposed in his first april joke post, would work better than what we have.
The doctrine of blindness also shuts down a lot of phenomenological investigation that’s important to understanding treatments.
Would it be possible to do some sort of meta-science on this topic?
Yes. I also care more for that then for chiropractors. I have no personal experience with chiropractic treatment nor know someone personally who has.
I’m not sure to what extend fascia is simply the latest buzzword or whether it a concept that yields a lot of new insight. The International Fascia Research Congress will be hold next year for the fourth time with makes it a pretty new field.
Somatics in general is possible to research by asking people to report their experience. It″s not straightforward. I took 2 1⁄2 years to understand a concept expressible in 21 words to the extend that I internalized it and could really use it.
The little literature there is on somatics feels like it’s making a bunch of trivial points but most of what matters is hidden in plain sight.
Standardizing that knowledge and structuring it in a way that’s well communicated by a book is a hard project.
Last year I had the experience of trying out my newly found perception ability. I noticed a friend strangely interacting with grass and after asking him what he’s doing he talked about it. I couldn’t perceive anything special about the grass. Then he suggested tries because they are easier and it was an interesting experience.
WIth that new found experience I went to my somatics teacher and asked her about perceiving trees to check if my own perception matches with hers and she found what I’m doing a bit strange. If her tree at the balcony needs water than she gets a feeling that it needs water but she never goes out and actively trying to perceive a tree. I felt like a child playing with his new toy while the adults consider that playing and experimenting immature.
It still don’t know whether I understand the full extend of the problem let alone the solution.
It’s not clear from the summary whether the control interventions were conventional best practice or not. The authors also noted most of the trials had high risk of bias.
Actually it should be quite easy to do science by comparing chiropractors’ diagnostic accuracy to diagnoses done by radiologists. If you can see it on an x-ray in superficial anatomy a chiropractor should definitely feel it. Also if there’s anything wrong with the positions of vertebrae that a chiropractor can feel an MRI would definitely show it. Do such trials exist?
Doctors do diagnostics manually too. The difference is they won’t tell you their subjective methods are out of the reach of science. Same goes for physical therapists, wonder why big pharma isn’t lobbying against them...
If it’s about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn’t necessarily show any evidence.
An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.
I know very little about how how societal attitudes about physical therapists formed and who’s responsible for it but I wouldn’t be very surprised if there isn’t someone on the payroll of big pharma out there who’s job it is to lobby for stronger standards of evidence for studies for interventions of physical therapists.
In practice many physical therapists also do a lot of things that aren’t backed up by studies that show that they work for a specific condition.
Point is if they can’t notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn’t avoid science even in this area.
fMRI is a dynamic modality for imaging the brain which has nothing to do with what we’re talking about. I was suggesting plain MRI, which is actually renowned for its accuracy in imaging soft tissues and not only bones.
Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.
One approach is to say: “Hey, this location feels off. If I do technique X this location doesn’t feel off anymore and the person feels better. They aren’t in pain anymore and their symptoms disappear.” It’s another problem to figure out the underlying biology and be able to say exactly what’s happening. That takes certain skills that usually don’t go hand in hand with being able to perceive locations that are off.
It’s also next to impossible to get funding for that kind of research. I know someone who does her PHD at using the kinect to do computer modeling of an proven physical intervention used by some physical therapists. There’s little grand money available for that kind of research. Most of the grant money goes to cell biology and biochemistry. Universities have to seek external funding these days and big pharma has money to throw around. Some science that is in principle doable isn’t done because there nobody to fund it.
I do think that risk of interventions is a concern but I don’t think it’s the driving force for mainstream beliefs about chiropractors. Given the inherent risk, it makes more sense to start with lower risk interventions.
As far as potential harm from interventions from physical therapists the risk is likely less, but I would be surprised if there’s no physical therapists that messed someone up.
Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.
What are your suggestions for how to most reliably evaluate anecdotal data? Would it be possible to do some sort of meta-science on this topic? How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)
I understand many medical treatments aren’t RCT based either but the fact that many are kind of makes me trust the mindset of health care professionals more.
And indeed it turns out they are: this is a pretty standard part of the alternative medicine anti-rationalist toolkit.
I haven’t made a simply argument against doing science in principle. I made arguments that you shouldn’t assume that everything there is to know is discovered by science_2014.
Hypnosis is basically about utilizing suggestion in efficient ways. If you do it right then you can switch off any pain with it. How can argue that this is basically placebo but that doesn’t change anything about the fact that the person isn’t in pain anymore and the person wouldn’t get the same effect if they would go to a person who’s not skilled at using suggestion.
Furthermore any somatic intervention by definition targets someone’s subjective experience. The notion of placebo’s doesn’t make any sense for somatics.
Instead of testing against placebo I would prefer testing against the Gold standard for treatment. A person who’s in ill cares whether he gets healed better by treatment A or by treatment B. He doesn’t care about placebos.
In some cases you can run additional trials with placebos to get additional knowledge, but comparison to Gold standards seems more important to me. Of course it’s good for big pharma to have placebo blinding as the default standard. That way there less pressure to show that new drugs outperform old ones and treatments that aren’t blinded as easily because they aren’t pills or injections get shun.
I also think that the system that Eliezer proposed in his first april joke post, would work better than what we have.
The doctrine of blindness also shuts down a lot of phenomenological investigation that’s important to understanding treatments.
Yes. I also care more for that then for chiropractors. I have no personal experience with chiropractic treatment nor know someone personally who has.
I’m not sure to what extend fascia is simply the latest buzzword or whether it a concept that yields a lot of new insight. The International Fascia Research Congress will be hold next year for the fourth time with makes it a pretty new field.
Somatics in general is possible to research by asking people to report their experience. It″s not straightforward. I took 2 1⁄2 years to understand a concept expressible in 21 words to the extend that I internalized it and could really use it. The little literature there is on somatics feels like it’s making a bunch of trivial points but most of what matters is hidden in plain sight.
Standardizing that knowledge and structuring it in a way that’s well communicated by a book is a hard project.
Last year I had the experience of trying out my newly found perception ability. I noticed a friend strangely interacting with grass and after asking him what he’s doing he talked about it. I couldn’t perceive anything special about the grass. Then he suggested tries because they are easier and it was an interesting experience.
WIth that new found experience I went to my somatics teacher and asked her about perceiving trees to check if my own perception matches with hers and she found what I’m doing a bit strange. If her tree at the balcony needs water than she gets a feeling that it needs water but she never goes out and actively trying to perceive a tree. I felt like a child playing with his new toy while the adults consider that playing and experimenting immature.
It still don’t know whether I understand the full extend of the problem let alone the solution.