Chiropractic Think Tank Launches Website

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The West Hartford Group, Inc., (WHG) is a chiropractic think tank dedicated to the advancement of the chiropractic profession in an ethical, responsible, evidence-based way.  The WHG is a pro-active and positive force moving in the direction of cultural, social and professional authority to improve the profession’s standing within the health care system and society.

Some of the members of WHG include such chiropractic notables as Michael Schneider, Richard Vincent, Stephen Perle, Donald R. Murphy, John J. Triano, David Seaman and Lawrence Wyatt.

 The West Hartford Group’s website was launched today.  Soon, position papers and other information will be added to help promote the non-surgical, patient-centered, spinal specialist model embraced by the think tank.  The website is located at:  www.WestHartfordGroup.com

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There is no Alternative Medicine…

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“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.” — Fontanarosa P.B., and Lundberg G.D. “Alternative medicine meets science” JAMA. 1998; 280: 1618-1619.

This quote was recently presented to me. While I understand what the authors were implying,  something was missed in the execution. The fact is that much of conventional medicine has been unproven and lacks solid data. Diabetes?  Heart disease?  Prostate cancer?  Spinal surgery? We do the best we can with what we have but this quote is an exaggeration.

Certainly the future must be evidence based and we must strive to discover the truth about what is effective, but being evidence-based includes utilizing treatments that the practitioner’s experience deems effective while awaiting evidence one way or the other.

Perhaps it would have been better stated, “There is no alternative medicine; there is only effective medical treatment and treatments that should be discarded.”

 

Dr. Brett Kinsler is an evidence-informed skeptical chiropractor in Rochester, NY

Ear Candling: Sure, It’s Waxy, But Is It Good?

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Dear Dr. Kinsler,

What do you think of ear candling?  My sister swears by it but I’m skeptical.

P.M.

Cleveland, OH

Stop me if you’ve heard this one… 

A guy walks into an alternative medical provider’s office.

AltMed Guy: Can I help you?

Guy: What?

AltMed Guy: Can I help you?

Guy: I can’t hear so well.

AltMed Guy: I SAID “CAN I HELP YOU?”

Guy: I heard what you said.  I think I’ve got wax in my ears.

AltMed Guy: Well allow me to stick this cone in your ears and light it on fire to draw out the wax using negative pressure.

Guy: Hahahahahahahaha

AltMed Guy: What’s so funny?

Guy: I thought I heard you say you were going to stick something in my ears and light it on fire.  Wow, my hearing must truly suck!

AltMed Guy: Actually, that’s what I said.

Guy: Oh, okay.  Well, while you’re doing that, could you poke something into my eyes and set that on fire, too?   

You’ve heard of this I’m sure.  Ear Candles. Also known as thermal-auricular therapy.  A hollow candle is placed in the ear and the end sticking out is lit on fire.  Supposedly, the heat from the candle creates a vacuum thus drawing out wax in the ear.  The proof is in the formation of a dark residue inside the candle.

Only, it’s not proof because ear candling is crap.  And dangerous crap at that.  In fact, studies have shown that ear candling not only doesn’t create negative pressure…the same junk is found inside the candle whether or not it’s lit inside someone’s ear. candlecompare

Sounds like it’s a better idea to just light money on fire and see if that helps your ears.  Except the danger from ear candling isn’t limited to its scamminess.  There have been reports of serious damage from the practice.  Hmm…fire near the face inside an opening of the skull…nope, I don’t get it.  Hot wax placed next to the eardrum?  No, I still don’t see the issue.  Open flame and hair?  I just don’t see what you’re driving at.  Anyhow, I’m not sure where the danger comes from but nonetheless I must recommend against this one.

Bottom line: ear candles lack any evidence of efficacy for any condition and do more harm than good.  Period.

Say what, now?

Dr. Brett L. Kinsler is a Rochester, NY chiropractor and produces the skeptical podcast On The Other Hand.

One Pill Makes You Larger And One Pill Makes You Lie

 

A person critical of chiropractic recently told me he believed the only reason chiropractic showed any effectiveness was entirely placebo effect.  He was wrong.  I’m not getting into that in this article.  However, it looks like he could have made a similar statement about many medical practices and not been too far off the mark.

It turns out, according to a recent study published in the British Medical Journal (BMJ), almost half of U.S. medical doctors use placebos with their patients.

If your doctor has prescribed antibiotics for the flu or told you to try B-12 vitamins for fatigue, those treatments were just a placebo — an unproven therapy offered with the hope you would feel better if you took something…anything.

Treatment with placebos is far more common than you might think, according to the national survey about 58 percent of U.S. physicians admitted using placebos regularly. Only 5 percent said they tell patients explicitly that they are doing so. The survey was sent to 1,200 internists and rheumatologists with a response rate of about half of them. 

Classic examples of placebos are sugar pills, saline injections and other treatments that seem to inspire confidence even though they are inert. But the physicians surveyed were far more likely to use active agents as placebos, including over-the-counter painkillers, vitamins, sedatives and antibiotics.  What classified them as placebos was the context. If the recommended treatment hasn’t been shown, physiologically, to work for the condition in question, then it was a placebo.

Two years ago, the American Medical Association said it was wrong to use placebos without a person’s knowledge.  But some make a case for what they call “benevolent deception” — letting a patient believe she’s getting a useful treatment because, paradoxically, it might work.  I think that when placebos involve medications like antibiotics and sedatives there is a line that has been crossed.  Furthermore, when the AMA code of Ethics states that “a physician shall … be honest in all professional interactions” I don’t see the wiggle room in there to tell Mrs. Smith that the garlic tablets you gave her will have a chance at curing her cancer.

So what’s to be done with patients who insist on a prescription for something they don’t need?  I say, educate them, don’t lie to them.  Tell them why they don’t need an antibiotic, give them a lollipop and send them home.

What do you think?

Does Scoping Knees Help Arthritis?

Arthroscopic knee surgery for people suffering from osteoarthritis is a popular treatment but according to a new study published in the New England Journal of Medicine, knee arthroscopy doesn’t actually reduce joint symptoms or improve function when compared with nonsurgical treatment.

Canadian researchers examined the effectiveness of arthroscopic surgery, the process of making small surgical incisions and inserting a thin, flexible fiber-optic scope and other small instruments into the knee joint to remove pieces of cartilage and smooth the joint surfaces. Arthroscopy is used to repair osteoarthritis as well as other knee problems.

The study treated 178 patients with moderate to severe osteoarthritis of the knee and an average age of 60 years old.  All patients recieved physical therapy and medications such as ibuprofen or acetaminophen but 86 of the patients also received arthroscopic surgery. They were then tracked for two years.

The researchers found that both groups of patients experienced similar improvements in joint pain, stiffness, and function.  At the end of two years, the researchers concluded that compared with nonsurgical treatment, arthroscopic surgery of the knee did not improve joint symptoms or function for people suffering from osteoarthritis of the knee.

It is important to note that the study focused on arthritis-related knee problems — arthroscopic knee surgery is still beneficial in other conditions that affect the knee, such as meniscal and ligament problems.

Patients who have a combination of knee problems, such as osteoarthritis and a meniscal tear might also respond better to arthroscopy.

Source: Kirkley, A. The New England Journal of Medicine, Sept. 11, 2008; vol 359: pp 1097-1107.

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