Friday, 19 August 2011

Chiropractic

Here is the beta version of my strip on chiropractic therapy. It's a little rough and will need proofreading from those of you with eyes sharper than mine. All comments welcome. This is, of course, a chapter of my upcoming Science Tales book, which will be out from Myriad Editions next year. Each chapter of the book will come complete with references and acknowledgements, including this one.


chiropractic 1

chiropractic 2

chiropractice 3

chiropractice 4

chiropractic 5

chiropractic 6

chiropractic 7

chiropractic 8

chiropractic 9

chiropractic 10

chiropractic 11

chiropractic 12

chiropractor 13

chiropractic 14

chiropractic 15

chiropractic 16

chiropractic 17

chiropractic 18

chiropractic 19

chiropractic 20

chiropractic 21

chiropractic 22

115 comments:

Acleron said...

Good review of the woo, you have covered all the bases I could think of. :}

Garen Ewing said...

Another fantastic and level-headed strip, Darryl. One typo that leapt out - "choise" instead of "choice", p.11 panel 2.

I wasn't aware that osteopathy was more respected - I used to believe it was until I had my neck violently wrenched round by a practitioner which frightened me right off going again, that plus reading about an old school colleague whose husband was paralysed form the neck down after a session. Of course that could be a very isolated incident - I'll read up more about the area.

Great work!

Box Brown said...

I love the color in this one Darryl! I think this is an important strip because I know in the US, Chiropractic flies under the fraud radar.

Darryl Cunningham said...

Garen. Still not too sure about osteopathy. That bit of info came out of Simon Singh and Edvard Ernst's book, Trick Or Treament. I need to to a bit more reseach on the subject and may yet change that line.

Don't let anyone touch your neck, seems to be a good rule.

PeeT said...

The only typo I could see, apart from 'choise' as Garen pointed out, was 'disfunction' on pg3. I think it should be 'dysfunction'. Lovely work as always!

mikekoz68 said...

What would you recommend tosomeone who claims to get beneficial treatment for back pain from a chiro? Refer them to a physical therapist instead?

Paul B Rainey said...

Another great strip, Darryl.

Yael said...

I've also noticed one typo, on page 8 - 'scisms' should be 'schisms'.


I've recently started taking sessions of Alexander Technique, recommended by an orthopedist that I saw for upper back pain (which turned out to be an accumulation of stress on the trapezius muscles, actually), and have been a bit worried that it might be some pseudoscientific practice like chiropractics, but so far it seems to be alright, mostly technical in a way - like a sort of very subtle exercise. And while (according to Wikipedia) scientific findings are inconclusive so far, at least it doesn't appear to support any anti-science stance.

Flit said...

Excellent comic. I noticed a few things that might be typos. I've always seen is spelt subluxation not sublaxtion. At 4.3 should it be guiding not guilding? And Yael already pointed out the schism at 8.1.

Most importantly the message is conveyed superbly. I enjoyed reading it immensely.

Insane Pencil said...

Excellent strip! You are making the world a better place with your work.

I believe that "tend" should be "tends" in the 10th block, 2nd panel.

E. Will said...

Only one typo I can spot:

It's "Saskatchewan." I should know. I live there. ;)

Excellent work as always, I look forward to the book.

Anonymous said...

In sequence with guy exercising:
The have been...

Matthew J. Brady said...

Page 11, panel 1, misspells "chiropractors" as "chiropracters".

Good strip as always, Darryl. One aspect I wonder about is the treatment of children. I've heard that many chiropractors practice spinal manipulation on young children, even infants, which seems ridiculously dangerous on such malleable, unformed bones and joints. It's stuff like that that, along with the religious fervor of its adherents, that creeps me out about chiropractic.

buzz said...

I went to a chiropractor for lower back pain & wound up in a hospital as a result. Anti-inflammation drugs, medical therapy, & regular spinal exercise brought the problem under control. I caution everybody against visiting a chiropractor for anything other than a basic massage.

Rohan G said...

Hi Darryl, great work again. In panel 19, the first word should be "there" not "the". Best regards.

gamer-geek said...

Echoing what Buzz said, I used to go to a chiropractor for lower back pain and found that only the "treatment" that was actually some massage techniques seemed to help. Now I just get an actual massage from a massage therapist and it always makes my back feel great. Avoid chiropractors like the plague.

Freyalyn said...

Excellent. Can't wait for the book - lots of people will get it as a present!

A Land Moose Reject said...

I love the use of truly scientific rebuttals like emotionally appealing anecdotes. Is making a work that will only be seen by those that already agree with you anything more than masturbatory?

Zeno said...

If you do some searches for osteopaths (in the UK at least), you'll find many of them claiming to treat non-musculoskeletal conditions such as infantile colic, asthma, bedwetting, ADHD and autism, just like many chiros.

Daniel J. Mata said...

When I was an infant, my mother took me to a chiropractor for constipation. After a few visits, the problem was gone. A few months ago, I woke up with a muscle spasm in my jaw. The doctor just prescribe pain killers and massage. I went to a chiropractor, and he found that the main reason was just a mild dislocation due to teeth grinding. After a few visits, my jaw was fine.

The sucess rate of a chiropracor is a high and dubious as any other doctor. An operation can go wrong, they don't read the xray properly, the prescribe the wrong drug despite having very little knowledge of the problem, they check you and tell you to come back next week. These happen just as frequently in other fields of medicine. To call it a pseod-science is just asinine. It just takes time to find a good one like anyone else.

Personally, I only go to chiropractors that use an activator. Those jolt the bone back into place rather than twisting and yanking it. It is a lot more effective. Aslo, x-rays are a scam. I'll give you that, but chiropractors don't tend to have the luxury of bilking referrals out of their patients.

Also, why are homeopathy and accupuncture pseudo-sciences? They have been proven to be clinically effective.

Stratocastermagic said...

Interesting stuff. I'm concerned, however, that connecting Palmer Sr's death to being run over by his son, before giving the 'official' cause of death as typhoid, with a qualifying 'Being run over can't have helped...' is rather unscientific and opens you up to criticism from those whose views you are challenging.

Stefing said...

Great work.
As someone who suffers from extreme back pain I've often noticed that chiropractors - or bone wizards to give them their correct name - often practice other mystical treatments as well, which works well as an indicator of the efficacy of chiropody!

Blue Wode said...

An excellent illustration of the problems with chiropractic.

However, I would point out that osteopathy in the UK is different from osteopathy in the US.
In her book, 'Suckers: How alternative medicine makes fools of us all', British author Rose Shapiro wrote the following about the differences:

Quote
“In America today there are more than 49,000 Doctors of Osteopathy (known as DOs) who are trained in orthodox scientific medicine with additional training in manipulative therapies. They have the same entitlements to prescribe and perform surgery as mainstream medical practitioners and make up 20% of all general practitioners is the US. The UK’s 5,000 or so osteopaths require no scientific medical training and so are more firmly established in the ‘alternative’ camp. Very few are MDs and many combine osteopathy with dubious practices such as naturopathy and cranial osteopathy."


@ Stratocastermagic

It seems to be fairly widely accepted that BJ Palmer had sociopathic/psychopathic tendencies, therefore it’s not too much of a stretch to suspect, that he attempted to murder his father (and was possibly successful). A Google search returns comprehensive info on the subject. Given the cultish nature of chiropractic, and its intense infighting - which has continued to this day - I think that Darryl was right to touch on the subject.

Aria said...

Daniel, I don't believe that homeopathy has been proven effective in clinical double blind trials. If you have a link to the paper detailing the results of such a trial please provide.

The placebo effect is strong I grant you but water does not have a memory no matter how much you shake it.

If anyone did manage to prove it worked under strong clinical experimental conditions then there was a fairly big prize they haven't claimed.

hanfan_uk said...

fantastic!
i like the fact that it is humourous and engaging, brilliant!
there's a 'be' before 'found' missing in penultimate picture.

Anonymous said...

After a thorough treatment of the chiropractic subject, I think your assessment of osteopathy is a bit offhand. Many DOs are still firmly devoted to mysticism, and I disagree with your assessment that they long ago shed their roots. Otherwise great strip!

trulylucky said...

the one GOOD thing...is that I worked for a chiropractor & my husband was a patient & that's where we met...in the chiropractor's office!!

daijiyobu said...

Wonderful, wonderful, wonderful.

And this is from someone with a chiro. in the family who believes in cracking the neck of newborns.

-r.c.

Reuven M. Rosenberg, D.C. said...

Doctors, nurses often use holistic medicine, chiropractic for themselves
http://www.chiroeco.com/chiropractic/news/11648/52/doctors-%20nurses%20often%20use%20holistic%20medicine-%20chiropractic%20for%20themselves/

You say that chiropractors don't get physical diagnosis. Please refer to the info on the chart:
http://www.chiroeco.com/chiropractic/news/11648/52/doctors-%20nurses%20often%20use%20holistic%20medicine-%20chiropractic%20for%20themselves/

OlmanFeelyus said...

It is a nicely paced and layed out comic and I found the history really informative. I find the mixing of what appears at first to be an objective piece with an actual very clear agenda to be a bit misleading. Maybe if you would cite all of your sources, it would make it clearer that you are trying to make an argument rather than just lay out facts.

I just started seeing a chiropractor and the experience doesn't seem to fit into any of the categories you described above. It's at a bone and muscle clinic with doctors, massage therapists and kinesiologists and the chirorpractor prescribed a treatment which involves exercise and massage and stretches, with only a small percentage of it being actual chiropractic adjustment. It feels like a much more holistic approach based on prevention and long-term treatment and so far doesn't seem flakey at all. It also has a goal and an end, so it's not about endless visits to the chiropractor. So far it seems to be helping. How does this fit in with your narrative?

I also never really knew what kind of doctor to go to for the problem.

ty said...

I heard that germ theory had been disspproven by a team of chiropractic scientologists.

Anonymous said...

I like it but my brother says its too long, and I tend to agree. Unless you are planning to turn this into a book... perhaps a shorter version could be made for the generation with short attention spans...

Not that Brighton, Mate said...

First – I love this. Second, I’m a picky editor, so feel free to ignore any of this as stylistic intrusion into your art. Third, I didn’t do my best work in the personal stories, because of the tears in my eyes (no doubt assisted by the wine in my belly). That said, here are my thoughts:

Panel 16 – “majority” vs. “all”
Panel 22 – Perhaps should read “None of this is at all scientific, nor is any of it backed by medical evidence”
Panel 23 – probably should end with “…” to be consistent with other frames.
Panel 41 – probably should end with “…” to be consistent with other frames.
Panel 45 – probably should end with “…” to be consistent with other frames.
Panel 67 – probably should end with “…” to be consistent with other frames.
Panel 77 – “are” should be “is”.
Panel 80 – “does” should be “dose”.

Anonymous said...

Hi,

I don't claim to be a doctor but I have made good experiences with a chiropractor treating my specific problem of sciatica (lower back and leg pain caused by a dislocated disc pressing on the nerve). I will try to describe my case as best I can.

I have left it untreated originally which caused the inflammation of the sciatic nerve to flare up. After six months, I (notoriously sceptical) sought ought both a surgeon and a chiropractor's advice. They both diagnosed me the same after a CT scan with a dislocated disc in my lower back as the cause of the inflammation and pain. The surgeon suggested to operate this and cut off the dislocated parts of the disc as to ease the pressure on the nerve and alleviate the pain. I declined the operation because of the risks associated with spinal surgery.

The chiropractor suggested spinal manipulation at the point of impact to ease the pressure on the nerve by the disc. Skeptical, I asked if this is a) possible, and b) permanent and agreed to a series of treatments to try it as it was less invasive than the surgery, but only after I was explained that the spinal manipulation was designed to remove direct pressure from the nerve by attempting to relocate the slipped disc back into the spine. The chiropractor made clear to me at this point that it was not possible to make any guarantees this would be permanent and i may need spinal readjustment periodically in the future to keep the disc where it is supposed to be.


After six months of no treatment (and no drugs) the inflammation was severe enough to hurt during standing up and sitting and impair general mobility. There were no signs of improvement.

I started treatment with 3 sessions a week, then 2, then 1, over a period of 3 months. The chiropractor used the Neurocalometer to measure the difference in temperature between the left and right side of my back, where a small amount of temperature variation (according to him) suggested an increased blood flow by various grades of inflammation. I am not medically qualified to judge whether this is measurable or relevant so I can't comment.

After 3 months of spinal adjustments, the pain got slightly better and after 5 months it got substantially better. At the same time the readings of temperature variations got less and less, again explained to me as the inflammation reducing in size and severity.

After 7 months of then weekly, followed by biweekly and monthly treatments the pain disappeared 100%.

I have no way of substantiating whether the treatment was responsible for this or not other than I generally felt better / in less pain after the spinal adjustment had taken place.

I used a lot of ice packs during the treatment period to ease the inflammation.

Throughout the treatment, i was treated professionally with the whole intent of reducing my inflammation directly through one specific treatment. At no time was I exposed to obvious humbug, unrelated treatments, wholistic or otherwise, we concentrated only on the nerve pain.

I have fully recovered from sciatic nerve pain that I had for over 6 months prior to beginning treatment. With the general improvement after each session and secondary inflammation treatment such as ice, i am unable to rule out that the chiropractor had a positive effect on my condition. While it is possible I have self-healed during this period, there is still a direct correlation between the frequency of treatments , the projected healing curve and what actually happened.

As a result I am unable to dismiss chiropractic intervention as unscientific or untargeted.

Simon

Regina said...

I guess I've been incredibly lucky with the chiropractors I've been seeing for the past 18 years. They've only made me better and better. After reading this, I'll stick with the wonderful chiropractor I now see, in order to avoid the scary people I guess are out there.

Kuro said...

I love how informative this set was. I'm a DO (Doctor of Osteopathy) medical student in the United States. My education has been quite identical to my MD colleagues with the addition of manipulative treatments, some of which I think of as 'woo' and others I believe to be very effective. Readers in the UK should understand that 'osteopathy' is a very different thing in the US.

Also, chiropractors in the US span a wide variety from those that are highly involved in 'woo' to those reasonable ones that DO and MD physicians respect and will quite often recommend. The relationship is only sometimes adversarial. The advice mentioned on neck manipulation is likely reasonable for the UK but there are, especially in osteopathy, safe and effective treatments focused superior to the shoulders. Just this week while rotating with an MD preceptor I performed an adjustment to relieve acute exacerbation of a chronic temporomandibular joint dysfunction including advice to use an anti-inflammatory (ibuprofen etc.) and heat to the area.

I also have been involved in research relative to cervical manipulations which, in our case, have demonstrated no benefit to the manipulation insofar as our research indicated. The argument that DOs have not abandoned mysticism is unfounded in my experience and ignores a comparable rate of mystical thought among MDs and other comparable fields; after all, many MDs have made anti-vaccination statements and the like.

Again, nice set. Thanks for producing it.

Anonymous said...

Freedom of choice is what it is all about for me. I am a Chiropractor and I became one after all medical attempts failed to help me. There is risk in all medical and alternative procedures. Amazing to me that massive numbers of individuals and families have been so duped to spend their hard earned money on "Useless and dangerous" Chiropractic care for over 100 years! Go figure...

Dr Michael Breneman said...

Freedom of choice is what it is all about for me. I am a Chiropractor and I became one after all medical attempts failed to help me. There is risk in all medical and alternative procedures. Amazing to me that massive numbers of individuals and families have been so duped to spend their hard earned money on "Useless and dangerous" Chiropractic care for over 100 years! Go figure...

Lisa said...

There's a word in the comic whose spelling surprises me - sublaxtion (page 4, for example). I suspect it isn't a misspelling, because you use it consistently. But in the U.S. I think that word is spelled "subluxation" - with four syllables instead of three.

I agree with others here who've said that osteopathy in the U.S. has not shed its mystical roots - the osteopath who was briefly my child's pediatrician was strongly opposed to immunizations, said she needed the bones in her skull realigned by him, and told us a variety of nutty not-scientific things about his unusual beliefs about the sources of disease.

I should confess, I am a happy user of chiropractic care, but not to cure any big mystical things ... it just sometimes makes annoying aches and pains (back, shoulders, hips, sometimes tingling in fingers too) vanish quickly for me. But I do see how more gullible folks can be harmed by the magical thinking my chiro probably spouts to others, and that's now giving me pause!

Anonymous said...

anecdotes arent science? Didn't you just use anecdotes to link neck manipulation to stroke?

Dr Robyn Stephenson said...

I think this cartoon strip, although quite funny at times, is a load of complete bullsh*t. I am a qualified Chiropractor, and I AM informed about many scientific facts, believe it or not, and perhaps you should also be aware that Chiropractic is not just a SCIENCE, but a PHILOSOPHY and also an ART. Chiropractors are not pure scientists, and anyone who claims to say we are...well, they're just kidding themselves! Please, wake up to yourselves, plenty of people in this world, regardless of their profession, are good, bad, or just plain average at their job. You don't see me 'bashing' the medical profession or other areas of health. I have good working relationships with other health professionals and have little time for cartoons like yours - which are exactly that: CARTOONS. They are for amusement only, providing NO real fact.
Thankyou for your humour, in that sense, it is quite appreciated. In knocking someone else's profession, however, it is NOT appreciated.

Dr. William M. Thomas said...

Historically, I believe it is fairly accurate, but as to the over generalization of chiropractic and chiropractors, it is inaccurate. I thought it was very well done, for the most part. Many chiropractors do not practice this way, and have almost forsaken their historical roots, of which I am thankful for, but I philosophically and in practice do not ascribe to the "old school" chiropractic use of subluxation. As a practicing chiropractor who became a chiropractor due to a profoundly positive experience with chiropractic care, I can tell you from experience and from performing thousands of adjustments, that chiropractic care is affordable and effective, when utilized properly. It was not until I became a chiropractor myself that I discovered that there are some chiropractors who are like you describe in your cartoon (a little "wacky" and unscientific), so there is some truth to what you have written. I am writing articles and have written articles about many of the topics you address in your comic, and I would be willing to help you with the accuracy of it if you would like to contact me. Many, if not most of the generalizations that your comic makes about chiropractic and chiropractors don't apply to the way I practice. You can read more about it on my website http://www.DrTChiro.com

Dr Joanne Hosack D.C. said...

What planet do you live on? Can't be earth, because that's where I live, and I've such great relief from Chiropractic adjustments since I was 28 years old. I'm now 67 and with less pain in my body than I had when I was 28. If Chiropractic did not help people, it would have died out years ago. It pings me off when I have to defend one of the healthiest choices of healthcare and wellness on planet earth.
One of the best things I have done was to marry a chiropractor. I saw good he did, and the thousands of patients that he helped. I became a Chiropractor myself.
My advice to you: Start looking for the good things in Chiropractic. Check out Oklahaven for starters. You might just be amazed.

StopThatAstronaut said...

Dr Joanne Hosack D.C. said...

This is totally not an advert. Why would I be advertising my services. Why yes, I am a chiropractor, but this is totally not an advert. No sirree, definitely not.

No thanks, Joanne.

Anonymous said...

Is brilliant. i am having an ivory tower problem atm: all we skeptics tell each other how clever we are but out there in the world people are still getting ill, not getting well, being misinformed and misinforming each other, not to mention getting poorer at the hands of quacks etc.

Anyway my suggestion is to replace the flea with a picture of an actual pathogen like a bacteria, virus etc.

Best

@wildscrutineer

Zeno said...

An interesting piece on a Canadian survey of chiropractors:

Chiropractic for non-spinal conditions

mcthfg said...

Awww, look at all the woo-meisters with their little feelings hurt.

Chiropractic is NOT science. It is mystical, magical woo. When it works in a double-blind test, then you can have all the credit you'd like. But until then understand that your profession is worthless, if not harmful. Sorry you wasted all that money.

People who have back pain should see a real doctor.

ziadax said...

Nice overview! Am ironically having some low back pain myself atm. Am not seeing a chiropractor for it and don't intend to.

I did notice a couple typos, but as I saw one pointed out already, so I'll just mention the other.

page 19, panel 1: "The have been..." should be "There have been..."

Best of luck with the rest of your Science Tales book! :)

Anonymous said...

Excellent work. I was a chiro-customer for years until I woke up

Tor Hershman said...

)))((((((
(-)...(-0
....U....
.[____].

Epinephrine said...

@Aria: The problem is that of course there have been successful clinical trials (blinded and everything) of acupuncture, homeopathy, and chiropractic. After all, if you set alpha at 0.05, 1 out of 20 trials of a treatment that provides no benefit will seem to indicate a benefit. To make it worse, you get experiments with multiple dependent variables, and investigators using alpha = 0.05 for all of the variables, rather than a family-wise error rate of 0.05. If you have 5 dependent variables (time to recover, level of perceived pain, etc...) your chance of getting a false positive on one of the 5 is higher (~22.6%) than if you were looking at a single variable.

Couple it with some issues where blinding may not be as effective as initially suggested, with publication bias (the file drawer effect), and you get a distorted picture of the effectiveness of these therapies. When a meta-analysis is performed, the effects typically disappear, since the random type 1 errors occur on different variables.

The fact is that one needs more than just a clinical trial result - you need replication, meta-analysis should support it, and it should ideally be grounded in science. Presenting a study with a positive effect is a good start, but replication is essential, and while there may be an appearance of repeated successes, they typically are simply collections of studies that happened to get positive results, and when analysed as a whole the effects disappear.

Smooth said...

I like how all the chiropractors put "Dr" in front of their names. What is your doctorate in, exactly? Why can't you give me a presription for my back pain? You aren't a real medical doctor? Then stop trying to pretend like one.
Show me some scientifically administered double-blind studies that show chiropractic is as effective as medical treatment with a lower cost and fewer side effects and I'll buy into your B.S. If it's as effective as you claim, then a simple double-blind study shouldn't be that hard to produce.

madder said...

Lovely stuff, as usual. I look forward to the release of your book!

And since you asked, and I haven't seen this one mentioned yet, I'll join in the typo brigade-- page 2 panel 4 should read "vertebrae" (the plural).

Anonymous said...

One typo (only did a quick read through)...

THERE have been numerous reviews... ("bum/hip" panel).

John C. Welch said...

For years, I had chronic lower back pain related to sleeping. I would wake up in such pain after laying on my back for any length of time that I could barely roll over or get out of bed.

So I went to my doc, (you know, the ones who Chiros love to call pill-pushers) and he said: "I'm not surprised. You're out of shape and you sleep on a rock-hard mattress. You could get a softer mattress, but that's not going to solve the actual problem. I recommend you get back into a program of regular exercise and pay some attention to your abdominals and mid-lower back. Anti-inflammatories won't hurt, but if you're taking them in the amounts you say, they WILL hurt you over time."

Basically: Stop being lazy.

Lo, without a single manipulation, just a bit of work on my part, et voila, the pain went away.

I guess my doc wasn't very good. He didn't recommend addictive pain killers or surgery at all. Just told me to stop being so lazy, and do the things I knew I should be doing anyway.

Anonymous said...

not so much a correction as a nitpick about some word usage.

on page four, panel 2 you use the word 'theory.' is that a proper using of the term here (colloquial vs scientific sense?) all i'm wondering is that if by calling it 'theory' is it giving it more rhetorical weight than saying 'conceptualization' or something similar? if chiropractic is a theory, and evolution is a theory does that make them equally valid, if you follow me. pseudo and anti-scientists often throw the phrase 'it's only a theory' around a lot to disparage things they don't agree with.

also, on page 10, panel three you list herbal rememdies with acupuncture etc, which i think at least the way it's phrased would be a weak point exploited by your critics. i could see them saying 'aha! this guy doesn't think herbs have medicinal effects (of course some do, but they vary in their usefulness, hence modern pharmacology rather than herbalism) therefore he doesn't know what he's talking about!'

so mabey rephrase as 'dubious herbal remedies?'

Anonymous said...

Page 11, panel 4 (I think, it's been a long day and I don't feel like double checking). Now, I know why you used it, and I don't expect you to change it but a heads up for next time: don't use a rod of Mercury/Hermes (aka caduceus)- Roman/Greek god of thieves, liars and businessmen*. You want the rod of Asclepius god of Healing which is one snake wrapped around a staff.

*the rod of Mercury is entirely apt but your intended audience comprises lay people who may not spot the joke

Darryl Cunningham said...

Dear Anon

The rod of Mercury thing is an entirely honest mistake, which I will change.

Jennifer said...

Whoa, I just randomly read your book yesterday before I saw the link to this on a blog today. No wonder the art style looked familiar. That's awesome. Keep up the good work.

Not that Brighton, Mate said...

Still love this strip, Darryl. Some more thoughts and suggestions (referenced by page and panel as X.X, or full page as X.0), which again I offer merely for your consideration, follow:

1.6: The word “tradition” seems somewhat inappropriate (for lack of a better word on my part). Maybe you could just say “Daniel David Palmer (born Toronto, Canada) invented chiropractic treatment in 1845.” Or something like that.
2.0: Funny “back” story on this: janitor claimed DDP just smacked him on the back after janitor delivered a punch line. And a rhetorical question (and perhaps a confession of ignorance): don’t auditory nerves (like optic nerves) run directly to the brain without entering the spinal column?
3.5: The final comma and the word “and” should probably be replaced with “to”.
4.1: The comma is unnecessary; perhaps subluxations could instead be set within quotes.
4.4: This comment contains a double-negative (“None … is backed by no medical evidence.”)
8.3: Another rhetorical question: Where do the “crackers” fit? Those who demonstrate success to their clients by generating cracking and popping noises from the clients’ back and other bones and joints as they work.
11.6: You may want to delete the first comma and change “exist” to “exists”, and then change the following comma to a semicolon followed by the word “those”.
12.6: I am neither a writer nor a grammarian, but in this panel does the word “proved” modify “regulatory inertia”? If so, and if I am not mistaken, it is not a part of the verb and thus should instead be “proven”.
15.4: At first, I thought that 15.3 and 15.4 had a tense shift (“there’s” to “wasn’t”), but the minor confusion for me might be eliminated by changing the text to “the medical community wasn’t able to make the connection between chiropractic therapy and stroke for many years.”
18.5, 18.6: Just an aside: Medical errors by MDs and DOs ARE subject to mandatory reporting and evaluation to determine ways to prevent the error from happening again.
18.6: Perhaps “medically necessary” would be better than “worthwhile”? While medical necessity is a US legal doctrine, I believe that the UK uses the phrase colloquially at least.
20.2: “Non-effective” should probably be “noneffective” or even better “ineffective”.
21.5, 21.6, 22.0: A final aside: in the US at least, chiropractors cannot claim to “cure” anything, for risk of conviction for practicing medicine without a license. Funny, in view of DD’s initial claim.

To chiropractors offended by this strip, I have had both good and bad experiences with MDs and DOs, and with chiropractors. My best experiences with chiropractors involved practices covered by insurance and integrated with other treatment facilities (physical therapy, etc.). My worst experiences with chiropractors involved obvious snake-oil sales and bone-cracking intended to convince me that I need more treatments. My best experiences with MDs and DOs are legion. My worst experiences with MDs have been indirect and involved those who encouraged patients and their families to pursue futile services (usually expensive services that might add to the physician’s compensation or at least not increase the physician’s cost), giving those patients and their families false hope in the face of terminal illness. My point: everyone has dirty laundry, and this strip is solely about chiropractic. Darryl has previously taken on evolution-deniers, the psychiatric profession, and if you give him time he will likely call BS on other medical professions. But give him some space – he is only one man standing against the Dalek swarm, in addition to attending to his publishing, his art, and doing his day job.

Keep up the excellent work, Darryl.

Alison Forrester said...

May have been said already but saw the line about don't let them touch you ABOVE the neck - shouldn't that be below??

Regards

Darryl Cunningham said...

Hi Alison

That statement does sound strange, but I think it means, don't let them hold you by the head in order to twist your neck.

Regards

Pieter B said...

Daryl --

You imply that BJ Palmer started buying radio and television stations prior to 1924. While he was a radio pioneer, acquiring station WOC in 1922, he didn't acquire his second station until 1929. WOC was reputed to be the second licensed station in the US. Definitely the first in Iowa and possibly the first west of the Mississippi.

Palmer didn't move into TV until 1947, according to this site: http://www.iowabroadcasting.com/bios/palmer_barlett_joshua

I question their information a bit, though, because they describe Palmer in the early 1920s going counter to the radio advertising format "widely used at the time." If you're one of the first few radio stations in the country, there isn't any format being "widely used."

BJ Palmer's Wikipedia page links to an article which disputes the story of BJ running over his dad with a car, which seems pretty well backed up. I'd add the link, but don't want to get caught in the spam filter.

dancestoblue said...

I have had good experiences and bad ones with both trad doctors and chiropractors, nothing so bad that the pain or symptoms were ever worsened but rarely did it improve, either. Most of my exp with chiropractors, relief in the short term, never release, never healing.

Two years ago I pulled a muscle high on my back or in my right shoulder, I don't even know, the pain was unbelievable and radiated everywhere. I went to my physician and he thank god trusted me enough to give me good pain medication or good enough so I could rest anyways, for 90 minutes after taking it. But absolutely on fire. Two massage therapists, one of whom I'd had great experience with, one who she (and others) also recommended -- small, slight relief/release while on their tables but absolutely no healing. The pain so intense I cried like a kid as they dug into the muscles, trying to loosen it. Nada. Nothing. They could find nothing, the muscle(s?) obviously spasming but ...

I was screwed.

In desperation, I asked a friend who'd told me of his luck with one chiropractor. I got on his table after telling him the story, he immediately found the muscle(s?) that were spasming and traced back to what was out of line and causing this to happen; for the first time in weeks I was out of pain. I was astonished. But to him it was matter of fact, same as a carpenter banging together a 2x4 wall, ho-hum, everyday, nothing to it. It only lasted about two hours but it gave me hope, and I went back two days later, and two days later, and don't you fools dare say that the guy was playing that game wherein you must go to a chiro til the end of time; I was healing the entire time, the relief holding longer after each adjustment.

Why am I spending all this time writing this here? Because it's my experience, it's what happened to me, and it is real. And I know my body, I'm no kid, this was real. I got tremendous help. Unbelievable, actually -- I thought that I was just totally screwed, the rest of my life in that sort of pain; you just can't imagine. Made me cry.

So I'm writing it so that others who may see the words I'm taking the time out of my Sunday night to write will be open to the hands of a caring, talented chiropractor. It might be that the commenters here have their reasons, and no doubt solid reasons, for taking such strong stands against chiropractors. But my experience is that if someone closes down the door to things without trying them when they are in desperation, in real pain, if someone closes to help extended, they are, to me, fools. Sorry folks; you can disagree with my beliefs or whatever but you damn sure can't tell me that what happened to me didn't happen, and you can't say that it may not happen for others.

I'm not saying to not be awake, alert, take responsibility for your choices, I'm not saying that luck -- in the form of finding a great chiropractor -- I'm not saying that luck didn't play a huge hand in it all, I'm not saying that there are not wacko chiropractors out there, any more that I'd say that there are no wacko doctors out there. What I am saying is that if you are in pain, and if you need help, you might also get lucky and get that help, as I did, through the care and treatment of a good chiropractor. I hope you never get the sort of pain I was in, hope also that if you do, you'll find the quality of help.

Number 80 said...

Hi Darryl

A nice piece of work and factually spot on. No way can chiropractic be equated with evidence-based medicine and no amount of bluster from chiros or anecdotes from patients can change that.

Thanks and best wishes

Anonymous said...

Third block, 5th panel: "everything from [blah blah blah]" you need a "to", as the proper construction is "everything from x to y." So it should say "everything from heart disease and measles to sexual dysfunction."

Final block, penultimate panel: "If a cure is ever discovered, it will found"... should be "will be found"...

Interesting strip. I didn't know any of this information (other than that DOs in the US are full-fledged medical doctors), but did have an unsuccessful experience with chiropracty many years ago. No damage was done, and I was given one bit of helpful advice, but the "cure" for my chronic lower back pain was not any particular exercise but rather a good, thick memory foam mattress topper, and regular general exercise (walking, recumbent bike, hiking...).

-eon-

Mark said...

Mmm... Smells like hypocrisy in here.

A significant (maybe the most significant) thrust of your argument would be that Chiropractic success stories are anecdotal while medicine is science based. There's some other historical stuff that isn't relevant, but that seems to be the key point. But did you ever consider _doing_ the research? If you feel so strongly about it, having some data to justify your opinion might help. Without that data it is ultimately your opinion, with no more justification than that which you assign to Chiropractic Medicine.

My even bigger problem (and the source of my opening statement) is that you make some pretty horrific assertions about the potential damage to neck arteries, but you fail to back them up with statistics. In essence, you are using anecdotal evidence to support your argument against Chiropractic medicine, which you accuse of being based on anecdotal evidence. Knowing if the risk is 1 in 100,000,000 manipulations or 1 in 100 manipulations would make a big difference. Lets not forget that there are some pretty significant risks associated with medical science as well.

Anonymous said...

Just so you all know. I am 26 years old, female and have my entire life been extremely healthy. No prior conditions, all blood workups always normal and MY VASCULAR HEALTH IN PERFECT CONDITION.

Now. Listen to this.

THIS HAPPENED TO ME. A chiropractor manipulated my neck and TORE THE INSIDE WALLS OF MY VERTEBRAL ARTERY. Almost causing me a brain stem stroke and DEATH. Thankfully, I had a smart ER doctor who caught it in time.

This happened 3 months ago.

I am still healing. I cannot pick up over 5 pounds. I cannot exercise (as I was running before 5 days a week), or do anything strenuous at all. I have to be on blood thinner for risk of stroke. I was in the hospital for 2 weeks and the ICU for 4 days. My neurologist, hematologist, internist, etc ALL have stated that the CHIROPRACTIC MANIPULATION CAUSED THIS.

This is a risk to ANYONE...healthy or not and chiropractors DENY this risk.

I am now in PT 2x a week and will continue to be for another 3 months most likely, and worry CONSTANTLY that I will have a stroke because my artery has not yet healed.

Take home message kiddos: NEVER LET A CHIROPRACTOR TOUCH YOU. I am living proof that this actually happens to HEALTHY people.

Anonymous said...

@ Mark -

The statistics are 1 in 20,000 adjustments. This is about 1 person with torn neck arteries a day. My neurologist told me this and pointed out research to back it up that he had. I am the one who just posted about how this happened to me. A happy and healthy 26 year old...well, i was.

John McLaughlin, MD said...

Actually, the statistics are that the risk is abotu 1:3 to 5.85 million of a vascular accident occurring.

The chiropractic profession did look at the data, as did the medical profession.

Current understanding is this:

There is no excess risk of a stroke from being treated by a chiropractor. The risk of having a stroke after seeing a doctor for neck pain and headache is HIGHER for GPs than chiropractors. If we correct for someone having a stroke in progress when they walk in the door of a GPs office... then the risk is statistically equal.

Why? People do to both types of doctors for neck pain and headache. Sometimes, there is an injury in progress (and the kind of problem that causes a stroke in these cases can then be triggered by turning around in your car, getting your hair washed, etc... the colloquial name for it actually IS "hairdressers" stroke.) That illness process in progress is extremely hard, if not impossible to detect... the way we usually see it is after a stroke has occurred, or JUST before.

No offense intended to those who have had a upper vertebral artery dissection, but to date... there has been no credible evidence that a chiropractor can actually do enough damage to tear those arteries if they are healthy. The amount of force needed to do so is in excess of what the bones of the upper neck can handle... they would break before the arteries tear.

As an MD, and a neurologist, I needed to post this to clarify...
It is not chiropractors who deny the risk: the medical community at large does as well.

If this kind of rare event were to happen, it was just about to happen... regardless of the type of doctor you went to see.

Mchiro said...

I am sorry that you have had such a bad experience with chiropractic. However how can the 10% of the US population that does us chiropractic as a form of natural drug free healing be incorrect?

Anonymous said...

I feel sorry for those who have never been to a chiropractor! There is about 10% of people who just don't get it and bash it. I feel sorry for you and hope that other people don't listen to your nonsense. It saves more lives every day, while medical doctors kill more lives every day...you choose. I know what I choose and everyone else I know who goes regularly to a chiropractor chooses....so sad for you and hope you want to heal one day....it's up to you! Those that are smart will follow what they know to be true. Seek destruction and you will find, seek healing and create an opportunity to be healed...! It's our live and WE get to Choose the quality of it!

JP said...

Scott Haldeman, MD, DC reviewed malpractice claims records for a 10-year period between 1988 and 1997. In reviewing the outcomes following the application of 134.5 million cervical manipulations (commonly referred to as the chiropractic adjustment), the records indicated that there were 23 reported cases of stroke or vertebral artery dissection (VAD). [10] Of this group, 10 of the patients had the complicating factors of high blood pressure, use of oral contraceptives, or a history of smoking, all of which are associated with vascular disease. The actual incidence of stroke or VAD following cervical manipulation was found to be one per 5.85 million cervical adjustments. That means that the average chiropractor could work for 1430 years (or practice 48 full chiropractic careers!) before they might be involved with this type of litigation.

Now compare this to just one year with NSAIDs:
One group of patients who rely on NSAIDs for pain relief are those suffering from rheumatoid arthritis. In 1998, Dr. Singh of the Stanford University of Medicine reviewed the records of 11,000 arthritis patients at 8 participating institutions. He extrapolated that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications (internal bleeding) and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.

The data speaks for itself.

LKE, D.C. student said...

First, I'd like to say thank you to Dr. McLaughlin for giving the correct facts regarding the potential for a CVA and Chiropractic manipulation. And, I will reiterate this point. Cervical manipulation has never been scientifically proven to be the singular cause of the artery rupture. It would have had to be something that was in progress at the time. As I'll touch on later, chiropractic students today are receiving much different training than when chiropractic first came around. We are being taught to be able to diagnose. The importance of taking vitals and doing neurological exams on patients before doing manipulations is being stressed. We are taught to recognize warning signs and red flags of something potentially more serious occuring in the patients.

Second, for those of you clamoring for scientific research, it is out there. You simply have to take the time to find it. I am currently a 2nd year student at a well-respected university in the U.S., and everything we do is scientifically based. Just like MD and DO students, we learn in depth anatomy, physiology, biochemistry, nutrition, pathology, microbiology. We are trained in diagnostics. We just learn how to treat pathologies in a different way. And we also understand that by adjusting C1, we're not going to cure cancer. However, it can help support the body during treatment and recovery. Why else would a successful and respected hospital chain like Cancer Treatment Centers of America have Chiropractors on staff?

I'm not saying Chiropractors can fix everything. There is a role for all of us in the medical field. However, for someone who does not want to load their body with medications, like NSAIDs which are harmful to your system, proper, well-trained chiropractic treatment is a great option.

There is a study that I read for my evidence-based practice class (EBP--> SCIENCE-based) that was in regards to using chiropractic as an alternative to back surgery. Group 1 went directly to surgery, with, if I am remembering figures correctly, about 60% of patients seeing improvement. Group 2 did 6 months of chiropractic care, again, with around 60% of patients seeing improvement. Of the 40% that did not have improvement, most went on to have surgery with less than 20% of those patients having sucessfully reduced/eliminated pain. My numbers may be off, but I can promise, not by much. But this does go to show that the research is available.

The whole purpose of chiropractic, in my philosophy, is to help a patient get better- whether it is through physical medicine (adjustments, massage, other soft tissue work), working with them on a proper diet and exercise, finding botanicals to treat certain things (and I hope readers realize that many of today's medicines are derived from botanicals, but taking them more directly from the plant itself is much healthier and oftentimes reduces side effects), or bringing in other modalities, like acupuncture (which research is coming out on that now, too). Natural healing first, and if that doesn't work, okay- go for the surgeries, go for the medications. My father was on 17-- yes, 17!- medications when he passed a little over a year ago. Most of those were to treat side effects of others. One study I read emphasized the fact that though in a few cases the conservative treatments were unsuccessful, the attempt to use them and the delay in seeking allopathic treatment was in no way detrimental to the patients. So, I ask, what is wrong with exhausting conservative (non-pharm, non-invasive) measures before moving on to others?

Blue Wode said...

John McLaughlin, MD, said “There is no excess risk of a stroke from being treated by a chiropractor.”

If you’re referring to the Cassidy study (which the American Chiropractic Association was quick to mail out to some 16,000 U.S. neurologists), then please note that it looked at the records of patients who were admitted for *head and neck pain* and compared medical visits with chiropractic visits to determine which group had the greatest number of strokes. However, it is on record that chiropractic patients have had strokes as a result of neck manipulation when they have been treated for problems unrelated to head and neck pain. For example,20-year-old Laurie Jean Mathiason had a fatal in-office stroke when her chiropractor manipulated her neck for a "tailbone pain".

Moreover, since there is no real way to detect a stroke in progress, and there cheaper, safer and more convenient options for treating neck pain and headaches (e.g. exercise), why would a responsible practitioner ever consider administering a neck manipulation?

With regard to your claim that there has been “no credible evidence that a chiropractor can actually do enough damage to tear those arteries if they are healthy”, and that “the amount of force needed to do so is in excess of what the bones of the upper neck can handle... they would break before the arteries tear”, it’s worth noting the following:

Quote
“…in a good hanging, the victim should not strangle to death (1). A good hanging should be set up such that there is a fall just far enough so that the first and second vertebral bodies are separated, breaking the neck and quickly killing the victim. You do not want them to fall too far, as the head may come clean off and that is aesthetically unpleasant. Most people who die these days from hanging do not get a ‘good’ hanging; they suffocate at the end of a rope, a particularly gruesome way to die. The vertebral artery is often damaged in suicidal hanging (2); “The vertebral artery was shown to be injured quite frequently (rupture, intimal tear, sub-intimal hemorrhage), namely in one quarter of all cases, and indeed in more than half taking into account the perivascular bleeding.” This easy injury is in part due to mechanical reasons “The vertebral arteries appear to be particularly susceptible to injury in trauma of the cervical spine because of their close anatomical relationship to the spine” (3). A passive hanging (no drop) gives about 686 Newton’s of force around the neck for a 70 kg human. In chiropractic, “the mean force of all manual applications (is) 264 Newton’s and the mean force duration (is) 145 milliseconds (8)”. So a chiropractic neck manipulation, for a short period of time, can provide 38% the force of a hanging. And a bad hanging at that.”
http://www.sciencebasedmedicine.org/index.php/chiropractic-and-stroke-evaluation-of-one-paper/

Blue Wode said...

LKE, D.C. student said: “…and I hope readers realize that many of today's medicines are derived from botanicals, but taking them more directly from the plant itself is much healthier and oftentimes reduces side effects”


How do you know that? What about the possible toxicity of herbal constituents, the presence of contaminants or adulterants, and potential interactions between herbs and prescription drugs?

Blue Wode said...

JP wrote: “…at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.”

That may be so, but for a true comparison with chiropractic spinal manipulation one would have to take into account the following:

1. No prospective randomized trial conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding.
2. NSAIDs taken at recommended doses for a short time are generally very low-risk for appropriately selected patients — particularly the relatively young not on corticosteriods, anticoagulants, alcohol or tobacco and without a history of ulcers or severe comorbid illness.
3. Many patients continue to take NSAIDs while undergoing spinal manipulation. Moreover, spinal manipulation can frequently cause an exacerbation of pain, which might cause some patients to increase or initiate NSAID therapy. [Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain and Symptom Management, 21(3): 238-242, March 2001]
4. Herbal recommendations seem to be common among DCs; some remedies have actions similar to NSAIDs, while others directly affect bleeding per se. A recent set of reports by the North American Spine Society includes an 18-page reference chart listing approximately 70 herbs with their uses, potential side effects, and (known) potential interactions.
5. While side effects of low-back manipulation appear to be very uncommon, some chiropractic back-pain patients also receive neck manipulation, which entails additional risks.
6. Manipulation is much more expensive than NSAID treatment. So if both are equally effective, manipulation would be much less cost-effective.

It’s worth reading the full commentary re the above here:
http://www.chirobase.org/18CND/03/03-03.html

It’s also worth remembering that packets of NSAIDs contain Patient Information Leaflets detailing risks. However, it is evident that not all chiropractors warn patients about the risks associated with their manipulative treatments. I would also venture that because the number of people taking NSAIDs is bound to be much higher than those receiving spinal adjustments, then NSAIDs are likely to be far safer. In addition to that, NSAIDs have been proven to work and their adverse effects are recorded and acknowledged:

Quote
“It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question—non-steroidal anti-inflammatory drugs (NSAIDs)—cause considerable problems, for example gastrointestinal and cardiovascular complications. Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.”
http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

Anonymous said...

I like your comics, and more people need to read them. I do however think you should stop using anecdotal evidence in them! You mention three people whose chiropractic treatment has been detrimental to them, but then you say at the end "citing a few examples of chiropractic success does not validate this form of therapy" ... you're being unscientific by citing these examples too.

Anonymous said...

Interesting post.
I am a practising Osteopath and want you to remember that not all professionals are the same. I have seen good and bad teachers, Doctors, Accountants and lawyers. The risks of adverse reactions increase when seeing incompetent professionals. Go to a poor surgeon and have a bad surgery. Have a bad teacher and never learn a thing. So I guess the best advice is to use recommended therapists either from friends or your GP. Unfortunately in the world we live in going by qualifications alone do not ensure risk free management.

Anonymous said...

A chiropractic office called me recently and the person on the phone started saying, "Welcome to the neighborhood, have a free chiropractic examination...blah blah blah" and I said, "I don't believe in chiropractors." The person said, "Oh, okay." and then hung up. I won that round!

Anonymous said...

I just wonder : who does this benefit to ? How much are you paid and by whom to do this ?
Amazing that a profession like Chiropractic which is so non scientific and dangerous, as you say, is more and more accepted world wide by the governments, health organizations (such as WHO), hospitals, etc.
Studies (that you can find on Pubmed) showing the effectiveness and the security of the chiropractic care say that you are a liar ! Why ?
If you are not paid by someone to do this, then as an honest artist, you should really investigate and ask the report done by the WHO for example on chiropractic and look at the references. Ask how come it is legal in so many countries if all you said is true ! Unless....

gjerziemarcaida said...

Nice cartoon. Great illustration of chiropractor. It explains all about chiropractor.
_______________
Chiropractor Melbourne

G.G said...

There are good and bad in every profession, as an investigator Sir you have demonstrated the early history yet failed to mention the current training and litrature, which makes you a bad investigator. the sad thing is you as a bad investigator have the power of pen. which will end up miss informing the public.
my question to you:
1- How much medical training the first medical doctor had?
2- just as those chiropractor that rely on stories without supportive evidance you are stating that there is not research, no efficacy of Chiropractic treatement. well where did you look? becuase the research is out there, but I guess it requires higher IQ to find it!
3- what is the history of Doctor of Ostepathic? They wouln't be in the picutre if thier founder didn't see a value in manipuation, also how come a DO 's manipulation is valid and not chiropactor manipulation?
aren't the same manipulation?
4- If manipulation is so bad how come PT, DO and almost everyone else want to get their hands on it?
In conclusion you are an example of a bad investigator, you should just stick to your cartoon and forget about investigation!!!

reillydiane said...
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To avoid getting the wrong chiropractor, it’s best to find the one that is highly recommended by your friends or relatives who have had chiropractic treatments. You can also search around the internet for an excellent chiropractor.
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Shlomo Baron said...

I like the comic strips and the thoughts. Though there are some points I find disagreeing with, I still find this article superb when it comes to content.

stephcr said...

Chiropractic care has been the only treatment that CURED me of my chronic neck pain, after having tried many steroids, pain meds, etc. The MD told me not to let a chiropractic touch my neck. I Ignored her and ran to a DC and have never looked back. DC's are a great source in this pill obsessed culture we call healing.

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To prevent getting the incorrect health care specialist, it’s best to find the one that is suggested by your buddies or family members who have had health care therapies. You can also look for around the internet for an outstanding health care specialist.

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I think I've been amazingly fortunate with the chiropractic professionals I've been seeing for previous times 18 decades. They've only created me better and better. After studying this, I'll keep with the amazing chiropractic specialist I now see, to prevent the terrifying people I think are out there.

Barry

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