by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA December 2013
134 Chiropractic Journal of Australia Volume 43 Number 4 December 2013 though observational evidence also plays important and philosophically interesting roles in other areas including scientifc discovery and the application of scientifc theories to practical problems.” 59 In recognition of clinical results, it is suggested that patient safety and satisfaction could be the ultimate forms of anecdotal evidence.57 This is demonstrated effectively when patient demand and voluntary presentation for care would fundamentally be based on positive clinical outcomes -- despite theoretical supportive evidence still emerging. In 2007, Rees addressed the issue of the suitability of formal fxed EBM for the clinical health sciences. He opined, "Where does this leave us (practitioners - au)? Should we abandon clinical trials? Of course not. They remain a potent way of determining whether interventions work. Should we accumulate trials and look at what a collection of studies says? Of course. What RCTs are not, nor systematic reviews, is an evidential gold standard. Just as we now realize that extrapolation from the bench to the clinic is fraught with hazard, so we are belatedly waking up to the fact that in the treatment of individual patients, all the evidence, from whatever source, needs to be considered. Knowing how to treat the patient in front of you still resists checklists and formalization. For the moment, anyway." 60 As raised by Lenzer and Rees,58,60 if there are serious questions concerning the suitability of the form that an evidence base should take for clinical medicine, other health professions must review their evidence base criteria as well. Even some aspects of the extensive reviews conducted by the Cochrane Collaboration have been queried by some.61 While this discussion is not offered as a form of scientifc conclusion, it is intended to offer a plausible comparison by highlighting a blatant contradiction within medicine. It would be hoped that a reasonable, open and scientifc mind might determine that there may be elements worthy of constructive discussion, further study and fostered collaboration. Expressed opinion on chiropractic concepts may be explored further, based on all known facets. The extent of available research may not be as prolifc at this stage, but it should be noted that research for the manual professions is essentially self-funded, and not subsidised by a manufacturing industry. The "Father of American Medicine,' and as a signatory of the Declaration of Independence Dr Benjamin Rush, must have foreseen the dilemma of containment of other health professions when he proclaimed in relation to the US constitution; "The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic. ... Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outft offers." 62 SUMMARY It seems quite incongruous that chiropractors should be singled out for criticism based on the questionable claim that chiropractic was based on debatable hypotheses and a dearth of supporting evidence,63 - in view of the comparable adoption in some quarters of medicine of the very same principles and administering techniques. Further, that osteopathy in Australia seems to have remained below the target area, despite having an almost identical model of care. The evidence presented here would suggest that opinion expressed on the ABCTV program 'Catalyst' appeared to have contradicted readily available published evidence that was not alluded to in the program.. In addition, this refereed material on manipulative management of paediatric patients is available in at least three medical texts and in many published medical papers - primarily in non-English language journals. The range of conditions addressed by manipulative procedures and their positive outcomes, is not only in the chiropractic and osteopathic literature, but also evident in those medical publications. Case reports, anecdotal and empirical evidence also record observations which reinforce chiropractic hypotheses. They are highlighted by the fact that those forms of evidence are also utilised by orthodox medicine and manipulative medicine. Further, there is growing reservations in the literature about the reliance of meta analyses and randomised controlled studies for the clinical health sciences.60 Finally, the claim that there is an absence of sophisticated neurophysiological research, as well as research on animal subjects underpinning these manual therapy concepts, is patently incorrect. One must conclude that the published medical evidence is not available in English language journals so that the opinions expressed on Catalyst and elsewhere are not adequately informed. CONCLUSION A corollary from these observations is that much of the opinion about chiropractic is just that - opinion that is misinformed and not based on available research and facts. One would hesitate to think that it is opinion based on opinion based on misinformed and unsubstantiated opinion. Even an unbiased cursory search would have revealed such evidence. To pass as authoritative and knowledgeable, such opinion must be fair, accurate, current and fully conversant on the topic. A claim to the effect that chiropractic is not scientifcally based cannot be sustained when its evidence itself is based on established and fundamental published medical science. The continued recognition and incorporation of chiropractic principles and practice into medical domains further contradicts this claim. Given the evidence of medical utilisation of spinal manipulative therapy for a range of visceral and other CONTRADICTIONS ROME
CJA September 2013