Hard News: Miracles just rate better, okay?
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@Sacha
Acupuncture is not in and of itself dangerous. The problems come because, like homeopathy and Chiro etc it often comes all wrapped up in anti science, anti medicine propaganda that tells patients not to take their necessary meds and peddles anti vaccination tracts. That offered by GPs should be immune from this of course.
Osteo on the other hand is just as dangerous as Chiro. They do not differ fundamentally. Both are based on an utter misunderstanding of biology. They are not even any good at treating bad backs. Neither is any other therapy beyond vertebral fusion for the worst cases. Physio is as effective, the difference is the physio is much less likely to harm you, is better regulated, fully integrated into modern evidence based medicine and so more likely to refer you on instead of trying to treat what they cannot etc.
We have bad backs because humans are not fully adapted to bipedalism yet and because in the modern world we don't do enough physical exercise and spend too long slumped in chairs and lying in bed at the weekends. I can no longer read in bed, I must get up and sit myself in a chair. The consequences of not doing so have been thoroughly impressed upon me. If I am insufficiently active various bits of me play up. Thus it is for all of us, use it or lose it. It's just that many think they should be able to live sedentary lifestyles pain and discomfort free. Chiropractors will tell you that regular visits for prophylactic manipulations will enable this. Your GP will tell you to take two ibuprofen before bedtime, take more exercise and lose weight (which will work, it did for me). But guess which most people will choose, even if it costs you more?
Add in that bad backs are something that often improves on their own, coincident with visits to the Chiro and combine with the fact that we are each an n of only 1 and we suffer from confirmation bias and remembering only the positive correlations and that Chiros deal only with glowing patient testimonials because trials are expensive and tend to give the 'wrong' answers and what do you get?
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@Ross Mason
One Osteo who knows when he is beaten does not a profession exonerate. That he knows some real medicine does not excuse the major, pre scientific, mistake that underlies his other diagnoses and treatment modalities.
I do not doubt the good intentions and desire to treat of many who become Chiros or Osteos, they are in fact victims too. Would that they had all become Physios, or Chiropodists/Podiatrists. But not everyone can get into those courses.
Spinal manipulation is not only dangerous it is unnecessary and not only does not achieve the desired aims but cannot because the biology does not work that way. Some of it is not even wrong.
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One Osteo who knows when he is beaten does not a profession exonerate. That he knows some real medicine does not excuse the major, pre scientific, mistake that underlies his other diagnoses and treatment modalities.
I went through this to the point of exhaustion in the other thread, but the short version is that I know that the C19th founding theory of osteopathy is bunkum -- but I've derived personal benefit from the clinical practice, which consists largely of massage (along with advice on exercise etc). All the other factors -- exercise, weight loss, good seating -- are vitally important, but I don't think I've simply imagined relief of what have at times been severe symptoms.
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And without wishing to start it all up again, even Stephen Barrett at Quackwatch (in Dubious Aspects of Osteopathy) grants that "Spinal manipulation may produce pain relief in properly selected cases of low back pain", citing this New England Journal of Medicine article, which concluded:
Osteopathic manual care and standard medical care have similar clinical results in patients with subacute low back pain. However, the use of medication is greater with standard care.
The authors noted that:
The osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) (P< 0.001) and used less physical therapy (0.2 percent vs. 2.6 percent, P<0.05). More than 90 percent of the patients in both groups were satisfied with their care"
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I don't think I've simply imagined relief
It's very important to note that placebos are not the same as you merely imagining relief. The placebo effect is real and can be measured.
Neither is there any shame or weak-mindedness in experiencing it. People get all upset when you say something worked by placebo effect, as though it's some kind of dishonour to have your body get the message and do the business.
There's also evidence that placebo effects are strengthened by things like how much the treatment cost, how much it hurt, how long it took, the perceived experience and prestige of the treatment provider and so on.
So I'm afraid while I truly believe you got better, and I am prepared to believe that the osteopath visit was the proximate cause, I am not accepting that as evidence of the efficacy of osteopathy.
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So I'm afraid while I truly believe you got better, and I am prepared to believe that the osteopath visit was the proximate cause, I am not accepting that as evidence of the efficacy of osteopathy.
I'm sure that there were various factors in my subjectively improved well-being, including trust in the practitioner, but my experience is essentially that of the subjects in the NEJM study and several others: I regained mobility and the pain eased.
It does seem unlikely to me that the effect was entirely one of placebo -- we're talking quite significant mechanical improvements in mobility on occasion -- although it is possible. If I'd experienced subjective benefit via largely identical massage therapy, would that have been different?
But it does seem odd to me than when a thoroughgoing skeptic like Stephen Barrett will grant benefit in lower back treatment, citing the study, you guys won't even countenance the idea because it offends you.
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If we treated these types of choices with the derision they deserve -- like we did with smoking and should do with obesity -- things would be much more inherently ka pai.
Hating and shaming people 'for their own good' is stupid, mean-spirited and disrespectful, and I object to it on about nine hundred different levels. It's hugely inappropriate.
(Additionally, the obese - who often do not 'choose' to be so - are shamed quite the fuck enough already, thank you very much.)
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Russ, the Cochrane Review is much better than any given individual study and they concluded from all their data that nothing works better than placebo. That includes scientific physiotherapy. The truth is that we have no good therapies for bad backs.
Also your personal anecdote does not equate to evidence since your n = 1 which means the stats is a no go. Which is why we have Cochrane reviews. I smell a confirmation bias allied with not wishing to think that you may have wasted your money.
Last time I had a bad back and it has been bad enough to lock me up completely, I cured it by digging the garden after it had calmed down (time + ibuprofen). I run and do various core body strength exercises as part of my warmup and I have had absolutely no problems since. No professionals were consulted or paid, not even a physio and I have numerous anecdotal examples of personally being put back together again by physios. Just not for my back.
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It's very important to note that placebos are not the same as you merely imagining relief. The placebo effect is real and can be measured.
It can be detected, certainly. But measuring its extent?
That link Russell provided was to a controlled study which used placebos. You've just waved it away and said it was all the placebo affect.
One of the things that really frustrates me about the medical-scientific establishment is its prejudice against things it does not have a way of explaining. Empirical data and direct observation trump theory in science. If the theory does not explain the observations, then the theory is wrong or (more often) incomplete - if something is observed consistently, then there is an explanation for it. It may not be the causal mechanism that is being suggested, but for every observed action, there is some kind of causal mechanism. Does that mean that the causal mechanism postulated by osteopathy is the cause here? Maybe, maybe not. But there is a real and observed result, greater than that expected in a placebo group.
I was sick of being told that the symptoms I observed in a medical condition I suffer were not real. That it was all in my head. It wasn't until I got a proper diagnosis of the exact condition that I found, via an internet discussion group, that these symptoms are common. If I had had less faith in 'science', I could easily have gone over to the quacks by now, at least for that condition.
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But it does seem odd to me than when a thoroughgoing skeptic like Stephen Barrett will grant benefit in lower back treatment, citing the study, you guys won't even countenance the idea because it offends you.
Not really all that odd. Medicine and science are as filled with preconceptions and prejudices as any other discipline.
Unfortunately, when scientists and doctors wave away what are real symptoms, or are dismissive of concerns (vaccines are a classic example), they give space to the anti-science brigade, who have no interest in standards of evidence and replicability.
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Treat GPs as gatekeepers/triage for the specialists and get passed on up if doubtful. The specialists should be current in the literature.
I always try and work out what part of my body is wrong, and then go to a specialist in that area. Failing that, I'll go to a GP, so they can send me to a specialist. The human body is very complex, and by their nature GPs can only give you general advice about anything other than common ailments. Best to go to somebody who knows the problem intimately.
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Your GP will tell you to take two ibuprofen before bedtime, take more exercise and lose weight (which will work, it did for me).
The best advice I ever got from a GP was "Take up swimming." It worked. I didn't even need the Vitamin I
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By measure its extent, I mean that you can observe things like changes in blood pressure. In other words placebo effects are not all in your head -- the cause might be in your head, but actual changes take place in your body that another observer can verify.
Actually, one interpretation of the article Russell has quoted is that conventional treatment is no better than osteopathy for back pain. Perhaps it was working by means of placebo too :D . Or perhaps it didn't work at all. I see that the study didn't have a group who received no treatment, so we don't know to what extent everyone would have got better on their own.
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Also your personal anecdote does not equate to evidence since your n = 1 which means the stats is a no go.
Jeez Peter ... I didn't say it was evidence, and I repeatedly used the word "subjective".
Which is why we have Cochrane reviews. I smell a confirmation bias allied with not wishing to think that you may have wasted your money.
In which case, I guess I'll have another one ;-)
Last time I had a bad back and it has been bad enough to lock me up completely, I cured it by digging the garden after it had calmed down (time + ibuprofen). I run and do various core body strength exercises as part of my warmup and I have had absolutely no problems since.
That would be ... an anecdote?
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NBH,
Just to correct a small error of Peter's : in NZ, since 2003 both Chiropractors and Osteopaths have actually been fully regulated professions under the HPCA, with statutory regulatory authorities and subject to the Health and Disability Commissioner.
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The present study indicates that OMT is a distinctive modality that significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.
The conclusions of the metareview; Licciardone JC, Brimhall AK, King LN (2005). "Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials". BMC Musculoskelet Disord 6: 43. doi:10.1186/1471-2474-6-43. PMID 16080794.
Obviously this isn't the final word, but it certainly is evidence.
Dispute causal mechanism. Say that osteopaths exagerate their efficacy, in often dangerous ways, and propose they can cure things they cant. But don't just wave away evidence you don't like.
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The best advice I ever got from a GP was "Take up swimming." It worked. I didn't even need the Vitamin I
I can thoroughly recommend that advice too. But that's just another anecdote. ;)
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Anyway, one more non-evidential anecdote:
Our older boy suffered a very unpleasant spasm that had his head locked onto his left shoulder -- he couldn't hold it up straight. We took him for a treatment (no "cracking" or anything) and he left the clinic walking straight and feeling a lot better. This seems to me to have been a better result than sitting around hoping it got better sooner rather than later.
@George:
Does that mean that the causal mechanism postulated by osteopathy is the cause here? Maybe, maybe not.
If you mean the C19th founding theory, I still think it's bunkum, allowing for the fact that your general well-being will be better if you're not in pain or discomfort.
But it seems to me that the clinical practice developed over years provides relief. And, as you and I have noted, there is some genuine evidence to support that impression.
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Meanwhile, the "founding theory" of osteopathy is bunkum, but I'm hardly surprised that having someone ask how you are (and listening) and effectively giving you a massage in a non-threatening, non-sexual environment leaves some people feeling rather more cheerful than they were at the start. And if that's how you want to blow your discretionary income, I don't quite put it on the same line of suck as snake oil salesmen pushing treatments that don't do shit to desperate parents or the families of stroke victims.
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Craig -
I take it you are not one of those peple who would pay to have the accupuncturist attach nice-smelling waddding to the ends of the inserted needles.....and set fire to it ? -
I found an article (2007) that appears to have a good go at checking what works and what might not,,,,,,there are others of course but I chose the latest of the bunch.
DO note the acknowledgement.
http://www.springerlink.com/content/6848751578nx0t42/fulltext.pdf
The abstract is here if you cannot download due to license issues
http://www.springerlink.com/content/6848751578nx0t42/
Its a study of the studies. The abstract states:
For acute LBP, the effect size of non-steroidal anti-inflammatory drugs (NSAIDs) and manipulation were only modest (ES: 0.51 and 0.40, respectively) and there was no effect of exercise (ES: 0.07). For chronic LBP, acupuncture, behavioral therapy, exercise therapy, and NSAIDs had the largest effect sizes (SMD: 0.61, 0.57, and 0.52, and RR: 0.61, respectively), all with only a modest effect. Transcutaneous electric nerve stimulation and manipulation had small effect sizes (SMD: 0.22 and 0.35, respectively). As a conclusion, the effect of treatments for LBP is only small
to moderate. Therefore, there is a dire need for developing
more effective interventions.The Study funded by:
Acknowledgment Dr. Hayden was supported by a Postdoctoral Fellowship Award from the Canadian Institutes of Health Research and the Canadian Chiropractic Research Foundation.
In other words, anything appears to work,,,....,modestly. Nothing like a touch eh? AND I fully concur with the power of the intimacy requirement!!!
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I take it you are not one of those peple who would pay to have the accupuncturist attach nice-smelling waddding to the ends of the inserted needles.....and set fire to it ?
I've had Moxabustion. (I'm assuming that by 'wadding' you mean mugwort, anyway.) It feels lovely. Not on needles though, as little cones burned directly on my skin. Obviously the underlying 'theory' is bizarre, but the effect is much like a nice warm pin-point massage.
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And if that's how you want to blow your discretionary income, I don't quite put it on the same line of suck as snake oil salesmen pushing treatments that don't do shit to desperate parents or the families of stroke victims.
I think part of Peter's argument was that the lovely purveyors of massage in a non-threatening, non-sexual environment are often promoters if not actual sellers of the snake oil as well.
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The parents who deal with it the worst are the ones who had it all planned out for their brilliant child.
You really have to let that go before you get anywhere
I'm pretty sure I fall into this category, at least somewhat. My first son had a stroke, and has subsequently been diagnosed with cerebral palsy, and more recently 'on the autism spectrum'.
Whilst I'm not expecting him to become a genius, I do wish to give him the very best opportunities that I can. Unfortunately, because he is 'special', the way to do this is not immediately obvious. Things that are appropriate for 'normal' kids may not be appropriate for him.
We receive a great deal of support through ACC, which makes us extremely lucky, but it's a double-edged sword to be exposed to so much expert advice. I find myself bordering on neurotic at times, in my indecision about when to treat Marcus' behavior as normal or not. I see all the time the way therapists work with him, and they encourage us to model around that, to use the same processes. Generally these things work, but they are also incredibly intense work, particularly for people who are not trained to it, who don't do it for a living, and who can't go home at the end of the day and be free from it.
I can fully understand when the therapists tell us that we are pretty unusual in mostly following their advice, and that most families just don't do anything they say, and pretty much leave their kids to themselves. I can even see the appeal of it.
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