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A number of concerns around chiropractic practice have been raised recently.1 Another concern is the use of unproven diagnostic techniques which can produce false diagnoses for which patients are told that they require often lengthy courses of treatment. Such practices have been described recently by a former president of the Chiropractors Registration Board of Victoria (in Australia), who said that some chiropractors misuse equipment such as thermography, and \"phrases such as ...'attract new patients' and 'keep your patients longer in care', are common enticements for chiropractors to attend technique and practice management seminars. \"2An example of the use of an unproven diagnostic technique to generate new clients was brought to my attention recently. A healthy active 28-year-old male saw a display in a shopping mall in a New Zealand city promoting a chiropractor clinic. The display stated that they offered advice regarding a number of conditions including poor posture. Although he did not have musculoskeletal problems, as his job involved sitting for long periods, he decided to have his posture checked.One of the staff scanned his neck with a thermography device and it was explained to him that hot areas represented in red were areas of abnormal stress. The staff member appeared shocked by the scan results and the young male became increasingly concerned when he himself saw that some readings appeared to go 'off the scale'. The staff member said that the reading was really high in certain areas of the neck and suggested making an appointment with one of their chiropractors. He was given a form to complete and bring to the consultation which included a signed consent to \"any radiographic examination that the doctor deems necessary\". After receiving advice from a medically-trained doctor, he cancelled his appointment.Although the report described above refers to a single episode, there is good reason to believe that such practices are widespread, based on chiropractic websites and advertisements and the comments quoted above. This raises a number of medical and ethical concerns related to chiropractic practice.Firstly, thermography is not a valid diagnostic technique. The American Medical Association has concluded that \"...in view of the lack of sufficient proof of effectiveness . . . the use of thermography for diagnostic purposes cannot be recommended\"3 and the American Academy of Neurology has stated that thermography has not been proven useful as a screening test for patients with back or neck pain.4Secondly, there is no good research evidence to support the use of chiropractic neck manipulation for any medical reason.5 In particular, there is no evidence to support its use in people with no known neck problems, but who have certain readings as recorded by thermography.Thirdly, chiropractic manipulation of the neck is strongly associated with severe adverse effects including stroke and is associated with numerous deaths.6,7 It is not known in this case if the man would have been informed of the possible risks, but it is unlikely given that the New Zealand Chiropractic Association argues that no such link exists,8 and the clinic's website describes these safety concerns as "junk science".Therefore this case describes the use of an unproven diagnostic technique, leading to an incorrect diagnosis of a musculoskeletal problem in an asymptomatic individual resulting in worry, unnecessary cost, and in all likelihood, unnecessary X-rays and a prolonged course of a treatment that is not only unnecessary but also could lead to life-threatening adverse effects.Patients rightly assume that any diagnoses made by healthcare professionals, particularly those who call themselves doctors, are accurate and that any recommended treatments are supported by clinical research evidence, have a positive benefit/risk profile, and are, above all, necessary. The motive behind this practice appears to be to generate clients from healthy individuals. Shaun Holt Tauranga

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Shaun Holt, Tauranga

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Holt S, Gilbey A. Backlash follows chiropractors' attempts to suppress scientific debate [letter]. N Z Med J. 2010 Jun 10;123(1316):126-7. http://journal.nzma.org.nz/journal/123-1316/4178/content.pdfSmith S. Chiropractic at a crossroad. www.australiandoctor.com.au/news/94/0c070694.asp Accessed 13/6/11H-175.988 Thermography update. AMA Council on Scientific Affairs, 1993, reaffirmed 2003.Substitute resolution No. 33: Efficacy of thermography. Passed by American College of Radiology House of Delegates, Sept 26, 1990.Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage. 2008 May;35(5):544-62. Epub 2008 Feb 14.Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract. 2010 Jul;64(8):1162-5.Leon-Sanchez A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J. 2007 Feb;100(2):201-3.Burt J, Owen D (on behalf of New Zealand Chiropractors' Association). A response to the letter \"Backlash follows chiropractors' attempts to suppress scientific debate\" [letter]. N Z Med J. 2010 Jul 16;123(1318):97-8.http://journal.nzma.org.nz/journal/123-1318/4224/content.pdf

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A number of concerns around chiropractic practice have been raised recently.1 Another concern is the use of unproven diagnostic techniques which can produce false diagnoses for which patients are told that they require often lengthy courses of treatment. Such practices have been described recently by a former president of the Chiropractors Registration Board of Victoria (in Australia), who said that some chiropractors misuse equipment such as thermography, and \"phrases such as ...'attract new patients' and 'keep your patients longer in care', are common enticements for chiropractors to attend technique and practice management seminars. \"2An example of the use of an unproven diagnostic technique to generate new clients was brought to my attention recently. A healthy active 28-year-old male saw a display in a shopping mall in a New Zealand city promoting a chiropractor clinic. The display stated that they offered advice regarding a number of conditions including poor posture. Although he did not have musculoskeletal problems, as his job involved sitting for long periods, he decided to have his posture checked.One of the staff scanned his neck with a thermography device and it was explained to him that hot areas represented in red were areas of abnormal stress. The staff member appeared shocked by the scan results and the young male became increasingly concerned when he himself saw that some readings appeared to go 'off the scale'. The staff member said that the reading was really high in certain areas of the neck and suggested making an appointment with one of their chiropractors. He was given a form to complete and bring to the consultation which included a signed consent to \"any radiographic examination that the doctor deems necessary\". After receiving advice from a medically-trained doctor, he cancelled his appointment.Although the report described above refers to a single episode, there is good reason to believe that such practices are widespread, based on chiropractic websites and advertisements and the comments quoted above. This raises a number of medical and ethical concerns related to chiropractic practice.Firstly, thermography is not a valid diagnostic technique. The American Medical Association has concluded that \"...in view of the lack of sufficient proof of effectiveness . . . the use of thermography for diagnostic purposes cannot be recommended\"3 and the American Academy of Neurology has stated that thermography has not been proven useful as a screening test for patients with back or neck pain.4Secondly, there is no good research evidence to support the use of chiropractic neck manipulation for any medical reason.5 In particular, there is no evidence to support its use in people with no known neck problems, but who have certain readings as recorded by thermography.Thirdly, chiropractic manipulation of the neck is strongly associated with severe adverse effects including stroke and is associated with numerous deaths.6,7 It is not known in this case if the man would have been informed of the possible risks, but it is unlikely given that the New Zealand Chiropractic Association argues that no such link exists,8 and the clinic's website describes these safety concerns as "junk science".Therefore this case describes the use of an unproven diagnostic technique, leading to an incorrect diagnosis of a musculoskeletal problem in an asymptomatic individual resulting in worry, unnecessary cost, and in all likelihood, unnecessary X-rays and a prolonged course of a treatment that is not only unnecessary but also could lead to life-threatening adverse effects.Patients rightly assume that any diagnoses made by healthcare professionals, particularly those who call themselves doctors, are accurate and that any recommended treatments are supported by clinical research evidence, have a positive benefit/risk profile, and are, above all, necessary. The motive behind this practice appears to be to generate clients from healthy individuals. Shaun Holt Tauranga

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Shaun Holt, Tauranga

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Holt S, Gilbey A. Backlash follows chiropractors' attempts to suppress scientific debate [letter]. N Z Med J. 2010 Jun 10;123(1316):126-7. http://journal.nzma.org.nz/journal/123-1316/4178/content.pdfSmith S. Chiropractic at a crossroad. www.australiandoctor.com.au/news/94/0c070694.asp Accessed 13/6/11H-175.988 Thermography update. AMA Council on Scientific Affairs, 1993, reaffirmed 2003.Substitute resolution No. 33: Efficacy of thermography. Passed by American College of Radiology House of Delegates, Sept 26, 1990.Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage. 2008 May;35(5):544-62. Epub 2008 Feb 14.Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract. 2010 Jul;64(8):1162-5.Leon-Sanchez A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J. 2007 Feb;100(2):201-3.Burt J, Owen D (on behalf of New Zealand Chiropractors' Association). A response to the letter \"Backlash follows chiropractors' attempts to suppress scientific debate\" [letter]. N Z Med J. 2010 Jul 16;123(1318):97-8.http://journal.nzma.org.nz/journal/123-1318/4224/content.pdf

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A number of concerns around chiropractic practice have been raised recently.1 Another concern is the use of unproven diagnostic techniques which can produce false diagnoses for which patients are told that they require often lengthy courses of treatment. Such practices have been described recently by a former president of the Chiropractors Registration Board of Victoria (in Australia), who said that some chiropractors misuse equipment such as thermography, and \"phrases such as ...'attract new patients' and 'keep your patients longer in care', are common enticements for chiropractors to attend technique and practice management seminars. \"2An example of the use of an unproven diagnostic technique to generate new clients was brought to my attention recently. A healthy active 28-year-old male saw a display in a shopping mall in a New Zealand city promoting a chiropractor clinic. The display stated that they offered advice regarding a number of conditions including poor posture. Although he did not have musculoskeletal problems, as his job involved sitting for long periods, he decided to have his posture checked.One of the staff scanned his neck with a thermography device and it was explained to him that hot areas represented in red were areas of abnormal stress. The staff member appeared shocked by the scan results and the young male became increasingly concerned when he himself saw that some readings appeared to go 'off the scale'. The staff member said that the reading was really high in certain areas of the neck and suggested making an appointment with one of their chiropractors. He was given a form to complete and bring to the consultation which included a signed consent to \"any radiographic examination that the doctor deems necessary\". After receiving advice from a medically-trained doctor, he cancelled his appointment.Although the report described above refers to a single episode, there is good reason to believe that such practices are widespread, based on chiropractic websites and advertisements and the comments quoted above. This raises a number of medical and ethical concerns related to chiropractic practice.Firstly, thermography is not a valid diagnostic technique. The American Medical Association has concluded that \"...in view of the lack of sufficient proof of effectiveness . . . the use of thermography for diagnostic purposes cannot be recommended\"3 and the American Academy of Neurology has stated that thermography has not been proven useful as a screening test for patients with back or neck pain.4Secondly, there is no good research evidence to support the use of chiropractic neck manipulation for any medical reason.5 In particular, there is no evidence to support its use in people with no known neck problems, but who have certain readings as recorded by thermography.Thirdly, chiropractic manipulation of the neck is strongly associated with severe adverse effects including stroke and is associated with numerous deaths.6,7 It is not known in this case if the man would have been informed of the possible risks, but it is unlikely given that the New Zealand Chiropractic Association argues that no such link exists,8 and the clinic's website describes these safety concerns as "junk science".Therefore this case describes the use of an unproven diagnostic technique, leading to an incorrect diagnosis of a musculoskeletal problem in an asymptomatic individual resulting in worry, unnecessary cost, and in all likelihood, unnecessary X-rays and a prolonged course of a treatment that is not only unnecessary but also could lead to life-threatening adverse effects.Patients rightly assume that any diagnoses made by healthcare professionals, particularly those who call themselves doctors, are accurate and that any recommended treatments are supported by clinical research evidence, have a positive benefit/risk profile, and are, above all, necessary. The motive behind this practice appears to be to generate clients from healthy individuals. Shaun Holt Tauranga

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Shaun Holt, Tauranga

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Holt S, Gilbey A. Backlash follows chiropractors' attempts to suppress scientific debate [letter]. N Z Med J. 2010 Jun 10;123(1316):126-7. http://journal.nzma.org.nz/journal/123-1316/4178/content.pdfSmith S. Chiropractic at a crossroad. www.australiandoctor.com.au/news/94/0c070694.asp Accessed 13/6/11H-175.988 Thermography update. AMA Council on Scientific Affairs, 1993, reaffirmed 2003.Substitute resolution No. 33: Efficacy of thermography. Passed by American College of Radiology House of Delegates, Sept 26, 1990.Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage. 2008 May;35(5):544-62. Epub 2008 Feb 14.Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract. 2010 Jul;64(8):1162-5.Leon-Sanchez A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J. 2007 Feb;100(2):201-3.Burt J, Owen D (on behalf of New Zealand Chiropractors' Association). A response to the letter \"Backlash follows chiropractors' attempts to suppress scientific debate\" [letter]. N Z Med J. 2010 Jul 16;123(1318):97-8.http://journal.nzma.org.nz/journal/123-1318/4224/content.pdf

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