Tuesday, 23 December 2014

Dr. Newell: – If not science then what, magic?

Dr. David Newell
On a Facebook-post by the American chiropractor Rob Sinnott, who is a member of the advisory board for the Foundation for Vertebral Subluxation, claimed that chiropractors could play a role in the fight against Ebola.  This bizarre statement has caused quite an argument within the chiropractic community, ultimately resulting in a call for evidence-based chiropractic to make a stand. Below, Research director at the Anglo-European Chiropractic College, David Newell, shares his thoughts on chiropractic, subluxations and the recent Evidence Informed Chiropractic Challenge (EICC).  

The interview is made by Dr. Joachim Tansemb Andersen.

During the ECU General Council meeting in Stockholm in late November David Newell informed the national presidents of the situation. It is now time to confront some of the extreme views and practices in our profession, said Dr.  Newell. 

So, how did the Evidence Informed Chiropractic Challenge (EICC) come about?

– Well here is the story. A few weeks ago somebody sent me a screenshot of a comment on Rob Sinnot’s Facebook-page regarding chiropractic care as a preventative measure for infection with the Ebola virus. I must admit I felt really embarrassed and angry. Not just for my colleagues and myself but also for the profession, particularly the new profession as represented by students coming through our education programs, because I know that the vast majority of these individuals and chiropractors out there do not share these extreme viewpoints. So as I felt it important to highlight how unhelpful such publicly stated views were, I sent an email to Matthew McCoy who is the Vice President of the Foundation for Vertebral Subluxation, with my concerns regarding Sinnott’s comments.

– At the same time, in connection to an ongoing debate around evidence informed practice, some of my students showed an interest in this particular case. And so I decided to send an internal email to the students at the AECC with my views. Within 48 hours both of my emails were up on Matthew McCoy’s website. Obviously I felt it only fair that I should have a right to reply and to comment on this on his blog, but again my attempts to make contact were unsuccessful, and in the end, posted my reply directly on my own Facebook-page. Everything else then kicked off from there and thus Andrew Vitiello, Mike Kondracki and myself decided to create the Evidence Informed Chiropractic Challenge.

What is the EICC, and what does it proclaim? 

– Well basically it is a website that we created because we wanted a public debate and a rational discussion about why we felt this wasn’t the right way to represent our profession.

By this you mean the post by Rob Sinnott?

– Yes. It represents an extreme view that I don’t think is helpful for the profession and that most chiropractors don’t agree with and indeed find bordering on the outrageous. Our intention was to bring this thing out into the open so that we could all clearly see what was going on.

Where would you see this debate taking place?

– We hoped for the debate to physically take place somewhere rather than being a complex discussion involving many individuals on social media. We did explore whether such a thing might happen at the WFC/ECU convention next year but that venues content and program had already been finalised. The other way we thought it might be arranged was electronically. We could have an open stream, online so that people didn’t have to travel, and we could put it up somewhere. But I don’t think it is going to happen either because so far these guys are not stepping up to the plate. We have tried to contact them and we have incontrovertible evidence of these attempts but as of now we have heard nothing back from Sinnott or McCoy concerning their willingness to have such a debate despite their protestations to the contrary.

Why do you feel it is wrong for chiropractors to talk about subluxations outside the MSK-domain, such as in the treatment of Ebola?  

– When we talk about a subluxation we have to remember that the word is used by a number of different groups and has a number of meanings. Amongst chiropractors these interpretations range all the way from those who believe in the word as put forth by early chiropractors, to the people that just think it refers to a restriction in the movement of the spine. And I’m ok with the latter definition. However, with so much baggage this word has accumulated it may seem somewhat confusing, not just within the profession but also when communicating with other healthcare professionals. So I don’t think it is a particularly useful term anymore. What we most definitely do not need is a description of what chiropractors do that involves ideas about a vitalistic life-force flowing up and down the spine, particularly if the removal of ‘subluxations’, as some call them, are explained as the causative agents of the restoration of life flow, which is what the extreme vitalists would tend to think, and is the idea, in my view and many others, underpinning Sinnott’s Ebola-statement.

– It’s not that I don't think that sorting someone's back out might potentially also affect the immune system a little bit, in the same way that reducing anxiety by being supportive of someone might also impact immune function. For example   managing or reducing someone's pain may very well impact immune function, mediated through cortisol or such mechanisms and perhaps a whole bunch of other things underpinned by discoveries in the scientific field of neuroimmune modulation. But it is not the removal of a subluxation that is affecting the immune system as claimed by some, it’s most likely to be simply because they’re out of pain and may feel better. And that shouldn’t be the core of what we as a profession say we can do, and chiropractors certainly should not be raising patients expectations that this is something chiropractic care can do. It could be a welcome positive side effect to helping people with musculoskeletal pain but it isn’t the thing that we aim to do. And with regards to evidence underpinning such effects it is either weak or non-existent, and if they are there at all, for most patients, they are likely to be very small effects. So are you able to affect the immune system to a point where Ebola won’t infect you(?), no of course not! That was, and remains a preposterous idea.

– So I have spent hours on different sites on the Internet trying to explain this. People now call me “the subluxation denier”, whatever that is. :-)

So are you saying that there is no room for the term subluxation?

– Well, I believe the word subluxation can be a useful term for some patients in terms of communication as a simple model that may help you and that patient come to some understanding of what you are trying to do. I wouldn't expect all patients to feel comfortable with complex scientific explanations using academic neuromuscular language for example, and in the end your patient is your central concern. However, we shouldn’t be using it to describe the type of interventions chiropractors can provide and maybe not as explanations of what chiropractors do for other healthcare practitioners. There, we should align ourselves with the terminology of mainstream healthcare professions, health care payers and policy makers using biomechanical, neurological and other scientific language when we explain what it is that we do. An important point to make here, and a common misunderstanding amongst groups outside the profession, is that chiropractic is not a treatment, it is a profession. Chiropractors provide chiropractic care, and that includes a whole bunch of different interventions and modifications of barriers to recovery within a positive clinical context coming together in a unique package. To individualise this successfully to a particular patient takes considerable intellectual, clinical and practical skills and a great deal of education and training. I think that we as a profession should be able to offer this to more patients than we do, along with other professions taking similar or different equally evidence based approaches. But for some patients that prefer our conservative manually based and supportive approach to managing their MSK conditions, we do indeed provide a unique and evidenced based additional choice. So I believe we should be up there at the top table talking policy with all of the other health care professions offering our expertise in helping to at least partly shoulder the enormous problem of MSK in our communities and to do this effectively, safely and at a cost that is acceptable to governments. However we are never going to get there if we continue to proclaim unsubstantiated effects using outdated, unscientific and turn of the last century language and ideas, and that’s simply my only argument.    

What are your hopes for the EICC?

– It would be really great to get everybody together in the entire profession from all sides and have a sensible debate. Some people might learn stuff – heck I certainly would learn a thing or two about what other people feel, because like everyone I have preconceptions or prejudices about what I think people are thinking.

– My dream would be to see the unification of as many chiropractors as possible under a common description of a model of chiropractic care. One that is patient centred, ethical, evidenced and uses scientific language to describe the use of different modalities and skills that chiropractors are trained to deliver competently and safely in the management of MSK problems. I know this has been already attempted by other organisations within the chiropractic profession but I wonder if it is time to draw a clearer line in the sand between the more extreme viewpoints in our profession and the majority of mainstream practitioners.

– I would love to see the profession pulling together underneath such a model but I don’t think we are going to manage that globally. I don’t even think we are going to be able to pull everybody together in Europe because I know there are factions in Europe that are extreme and take a fundamentalist approach to their beliefs about what they think they are doing and what chiropractic care is. And as much as I want it, I don’t think there is enough, if any, common ground to be found between some of these factions.  Maybe what we could do is write a bunch of statements that European chiropractic institutions can feel comfortable with and that maybe defines a European model. And that model would be evidence based, it would be professional, it would be all those things that I’ve been arguing for. And I would like to see these statements posted up on the websites of chiropractic institutions. So that whenever people say, well what’s your model of chiropractic(?), we can say there you go, that’s what we subscribe to, this is who we are and who we are not.

Do you see a danger in this leading to more diversity rather than unification?


– I can see that it is a tricky line to walk. My passionate wish is for unity. I don’t want to see any more splits and disharmony than we already have. But I don’t think complete unification is achievable. What we can hope for is that the majority of the profession can find common ground. Indeed I think out there on the ground it is already there to a great extent. It is possible that some will just not be able to work with such an explanation of what chiropractic care is and what our profession feels it can claim, and maybe it will cause some to walk away. But I hope it will be those with the most extreme view that will leave and leave the vast majority of committed, compassionate, professional chiropractors to unite under a description of a 21st century health care profession with so much to contribute to its patients, communities and society as a whole.

6 comments:

  1. If anyone would like to have their views expressed, either by voting or leaving a message, you can visit the EICC webpage athttp://eicchallenge.weebly.com/

    Thank you Oystein for all the work you do for the chiropractic profession

    Andrew Vitiello

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  2. As far back as 1991 peer reviewed, double blind research has been done showing that the immune response is increased by as much as 8X following an adjustment. Triano and Brennan published a paper proving that TNF increased in the blood from 0-80 picograms/Dl to 800 picograms/Dl following an adjustment. This did not occur in the sham group or the control group proving the adjustment did in fact raise the circulating TNF. TNF is synergistic with the immunoglobulins thus a specific correction of a vertebral subluxation can in fact increase the immune response and decrease the risk of any dis-ease effecting the human body. I agree that chiropractic can not "treat" anything but it can detect and correct subluxations with a specific, scientific, chiropractic adjustment...nothing more, nothing less.

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    2. I'm afraid this does not 'prove' anything Jay let alone that adjustments enhance immune function. Additionally, given the fact that this was published in 1991 I would have thought there might be a tsunami of ensuing evidence that would have put such an effect beyond doubt by now. I dont see it??

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  3. Brennan PC, Triano JJ, McGregor M, Kokjohn K, Hondras MA, Brennan
    DC. “Enhanced Neutrophil Respiratory Burst as a Biological Marker for
    Manipulation Forces: Duration of the Effect and Association with
    Substance P and Tumor Necrosis Factor” J Manipulative Physiol Ther
    1992; 15(2): 83-90.

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  4. It is important to read the actual research papers being cited (including understanding what "double blind" means, and be able to identify it in context.)

    Additionally, it is important to have a basic understanding of human immunity, as well as the biologically plausible mechanisms through which compression of the thoracic cavity may affect lymphocytic changes and how those mechanisms compare to those created by a "specific chiropractic adjustment"

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