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Chiropractors resort to legal intimidation

August 8th, 2008 · 57 Comments

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An editorial in today’s issue of the New Zealand Medical Journal prints in full a letter sent to the Journal by Paul Radich, a lawyer who acts for the New Zealand Chiropractors’ Association Inc and its members. The letter alleges defamation by Andrew Gilbey’s article, and by my editorial which sets the wider context of his paper. The articles in question are here.

Here are some quotations from the Editorial by the Journal’s editor, Professor Frank A Frizelle, Department of Surgery, Christchurch Hospital, NZ. [Download the whole editorial].

In the article by Gilbey, data is provided about use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy while the greater context is provided by Colquhoun.


The comments made by Paul Radich are entirely consistent with the response as expressed by Professor Edzard Ernst (Editor-in-Chief of Focus on Alternative and Complementary Medicine (FACT) and Chair in Complementary Medicine at the University of Exeter) in his humorous article In praise of the data-free discussion. Towards a new paradigm5 when he states “data can be frightfully intimidating and non-egalitarian”.

. . .

The Journal has a responsibility to deal with all issues and not to steer clear of those issues that are difficult or contentious or carry legal threats. Let the debate continue in the evidence-based tone set by Colquhoun and others.

I encourage, as we have done previously, the chiropractors and others to join in, let’s hear your evidence not your legal muscle.


My article said nothing that has not been said many times before. I regard it as fair scientific comment, and I believe that expression of those opinions is in the public interest, The reaction of the Journal is thoroughly admirable.

The outcome of legal bullying can be very counterproductive, as the UK’s Society of Homeopaths found recently to their cost.

The lawyers’ letter demanded a response by 11th August, but in the advice of a lawyer I have decided to ignore for now this rather crude attempt to stifle discussion.

For further developments, watch this space.

The story was picked up within hours, It seems that a storm may be brewing round the world for New Zealand Chiropractors. Here are some of them.

Silence Dissent Ben Goldacre’s badscience,net

HolfordWatch Professor Frizelle’s Instant Classic: Let’s hear your evidence not your legal muscle

The first New Zealand site.

More Legal Chill -from spine-cracking chiropractors on jdc325’s blog

And A beginners guide to chiropractic, on the same site.

Andy Lewis’s Quackometer takes a sharp look too, in They are bone doctors aren’t they?

Support from a NZ blog, Evidence-based thought NZ Chiropractors vs NZ Medical Journal

And another New Zealand blog, Chiropractors attack NZ Medical Journal on SillyBeliefs.com

and another: Evidence should trump “legal muscle”, on “Open Parachute. The mind doesn’t work if it’s closed”

New Zealand Doctor magazine. “Kiwi-practors legal wrangle” in the Nature world news blog, The Great Beyond.

“Self-destructing chiropractors” on Jonathan Hearsay’s blog is particularly interesting because he is a (sceptical) osteopath. He says “Chiropractors are seemingly hell-bent on destroying themselves as a therapy”.

There are now so many allusions on the web to the behaviour of the New Zealand Chiropractors’ Association Inc that I’ll give up trying to list all of them. Their action seems tp have done much to damage their own reputation.

Shortly after this came the news that the British Chiropractic Association is to sue one of out best science communicators, Simon Singh, because he had the temerity to inspect the evidence and give his opinion about it in the Guardian. His original article has gone (for now) from the Guardian web site, but as always happens with attempts at bullying and intimidation, it is more easily available then ever, For example here, and here.

Chiropractic in the UK is analysed by Andy Lewis on Quackometer,

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Tags: chiropractic · chiropractor · defamation · intimidation · lawyers · New Zealand

57 responses so far ↓

  • 1 Dr-star-T // Aug 8, 2008 at 11:56

    That’s a great quote:

    “let’s hear your evidence not your legal muscle.”

    Do chiropractics *actually* believe in ‘innate intelligence running through the nervous system’? Incredible.

  • 2 jdc325 // Aug 8, 2008 at 13:22

    Like Dr* T, I’m impressed with the NZMJ response. I’ve seen attempts at legal threats and bullying on so many occasions now – it seems to be a widespread Altie tactic. Apart from the letters sent to you/UCL by Anne Walker and Patrick Holford, I’ve seen the SoH attempt to silence legitimate criticism on the Quackometer blog (which was later followed by a self-styled ‘maverick’ successfully petitioning the Little Black Duck’s internet hosts to remove his blog). John Briffa warned me of possible legal action because I allowed comments on my blog that he deemed ‘defamatory’ (they certainly weren’t, though) and I remember John Garrow being told once that he was defaming Ms McKeith by remarking on the lack of published research carried out by her.

  • 3 RS // Aug 8, 2008 at 13:39

    So every time an altie denigrates conventional medicine we can sue?

  • 4 Professor Frizelle’s Instant Classic: Let’s hear your evidence not your legal muscle « Holford Watch: Patrick Holford, nutritionism and bad science // Aug 8, 2008 at 14:48

    […] dcscience.net with Professor David Colquhoun who is (of course) entangled in this legal imbroglio: Chiropractors resort to legal intimidation. Dr Ben Goldacre has a strong commentary on this matter: Silence Dissent! While chiropractors […]

  • 5 jdc325 // Aug 8, 2008 at 15:10

    “The outcome of legal bullying can be very counterproductive, as the UK’s Society of Homeopaths found recently to their cost.

    For further developments, watch this space.”

    … cool! Holford Watch and Bad Science are on it already.

  • 6 Twonilblankblank · New Zealand Chiropractors Association/Murray from Flight of The Conchords is pretty cool // Aug 8, 2008 at 19:06

    […] to sue the New Zealand Medical Journal over an article that was critical of chiropractors written by David Colquhoun.  I’ve picked up on this via Ben Goldacre’s Bad Science blog.  It’s a stupid […]

  • 7 Blue Wode // Aug 8, 2008 at 19:25

    It’s worth remembering that the New Zealand Chiropractors’ Association isn’t the first professional chiropractic body to use intimidatory tactics towards critics of chiropractic. For example, paragraphs 142-147 of Sandra Nette’s June 2008 lawsuit claim show that the Alberta College and Association of Chiropractors (the chiropractic regulatory body in Alberta, Canada), had no qualms about using similar strategies in the recent past:

    Para. 147:

    “The College went further in its bad faith by chilling and seeking to prevent scientific debate. Through the Canadian Chiropractic Association, its response to the statement of the Canadian neurologists and chiefs of neurology departments of major teaching hospitals in Canada was to individually threaten each and every one of the physicians whose name was associated with the statement with professional disciplinary action, with challenges to their standing and accreditation with hospitals and with legal action on the basis that their warning the Canadian public and governments about the dangers of neck manipulation was defamatory to chiropractic.”

    The link to Sandra Nette’s full Statement of Claim can be found here:
    http://www.chirobase.org/08Legal/nette.html

  • 8 Blue Wode // Aug 8, 2008 at 20:14

    Dr T wrote: “Do chiropractics *actually* believe in ‘innate intelligence running through the nervous system’?”

    They do in the UK:

    “We recognize that interference to innate intelligence (Subluxation) diminishes healing capacity, with an alteration in the dynamic interrelationship between mental, physical and social aspects of the whole person.”

    More…
    http://www.united-chiropractic.org/modules/content/index.php?id=4

  • 9 urban » Blog Archive » New Zealand chiropractors threaten academic journal // Aug 9, 2008 at 06:45

    […] The New Zealand Chiropractors’ Association Inc’s lawyer has sent a threatening letter to the New Zealand Medical Journal, alleging libel in two articles in their last issue. Full story on David Colquhoun’s blog: Chiropractors resort to legal intimidation. […]

  • 10 jonh // Aug 9, 2008 at 22:43

    I’m going to add something here – and, in doing so, I’m going to be skating on very thin ice. As an osteopath (small ‘o’, and a Mr. to boot – but I NEVER let people think I’m a surgeon!!!) I’m tarred with the same brush as the chiropractors, but only in the same way that a manipulative physiotherapist is. Broadly speaking, on a VA scale you have non-manipulative physio in the left corner, chiroqaucktors in the right and I fit somewhere in the middle.

    Now, I’m a bit of a professional let-down for my peers – largely due to the fact that I work full-time for the NHS and, more recently, due to my blog.

    http://jonathanhearsey.com

    For the NHS I have a strict brief where I practise only where (limited) evidence says I might be a reasonable alternative (see my blog). This has worked well for the last 12 years.

    At the risk of distancing myself further from my peers I really must agree with the main ‘thrust’ of this post (ignore the pun). Chiros have always had the upper hand on the commercial front – it’s in their blood. As CAMs ‘develop’ there is always the chiro-example-of-success to spur them on. I see a growing trend of a more commercial-bent to modern CAM practitioners and this scares me more than the lack of evidence that their disciplines have. With commercial success comes the delusion of power and with this delusion comes the wealth of protection borne from the association with lawyers, accountants and other such professionals.

    To me, science is like the debating society at school – you argue during the lunch-break but are friends when the bell goes for double maths. Chiropractors in NZ are not playing the game – they don’t want to debate, they just want to steel your curly-whirly and give you a wedgy. Why? Because they can.

    Keep these posts going – and please support the quacks that do know their place.

    JH

  • 11 Lindy // Aug 10, 2008 at 11:15

    Interesting link Blue Wode. The United Chiropractors Association (Doesn’t ‘UCA’ make you think they might be somethiing to do with a university?) website is full of truly grand words.

    I specially like all the ‘philosphy’ stuff, but also,

    ‘Conservative ethic: Our belief in the body’s ability to heal itself logically implies that the best care is the least invasive care’.

    Quite so. Whilst their methods do not involve overtly invasive procedures, you could still question their activites in relation to this notion, specially when the treatment may result in damage.

    and
    ‘Humanism: We ascribe to the belief that individuals have immutable rights’. Not sure where that comes in.

    The British Humanist Association (http://www.humanism.org.uk/site/cms/contentChapterView.asp?chapter=309 ) says, amongst other things, under What is humanism?

    ‘Humanism is an approach to life based on humanity and reason – humanists recognise that moral values are properly founded on human nature and experience alone. Our decisions are based on the available evidence and our assessment of the outcomes of our actions, not on any dogma or sacred text’.

    Evidence? Subluxations? No dogma?

    And of course ‘jonh’ is right in that this particular branch of non-evidence-based ‘therapy’ is extremely wealthy – as DC pointed out in his NZMJ article: this seems a likely reason for setting up of the General Chiro. Council.

    I think as many people as possible should grab at every chance to challenge the claims made by unscrupulous ‘wellness-mongers’.

  • 12 Blue Wode // Aug 10, 2008 at 15:30

    Lindy wrote: “And of course ‘jonh’ is right in that this particular branch of non-evidence-based ‘therapy’ is extremely wealthy – as DC pointed out in his NZMJ article: this seems a likely reason for setting up of the General Chiro. Council.”

    Indeed. There seems to be no other valid reason for the General Chiropractic Council to have included “promoting the profession” in its remit:
    http://www.gcc-uk.org/page.cfm?page_id=7

    Lindy wrote: “I think as many people as possible should grab at every chance to challenge the claims made by unscrupulous ‘wellness-mongers’.”

    Quite. If chiropractors’ provision of ‘wellness care’ really did work, then it would be reasonable to assume that their longevity would be on a par with that of medical doctors or, at the very least, the general population. However, according to this recent survey from the U.S. – which was conducted by a chiropractor – chiropractors’ life-spans are shorter than both:

    Quote:
    “Two separate data sources were used to examine chiropractic mortality rates. One source used obituary notices from past issues of Dynamic Chiropractic from 1990 to mid-2003. The second source used biographies from Who Was Who in Chiropractic – A Necrology covering a ten year period from 1969–1979. The two sources yielded a mean age at death for chiropractors of 73.4 and 74.2 years respectively.

    The mean ages at death of chiropractors is below the national average of 76.9 years and is below their medical doctor counterparts of 81.5.”

    Morgan, L. Does Chiropractic ‘Add Years to Life’? J Can Chiropr Assoc. 2004 September; 48(3): 217–224
    http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-3-P217-224/$file/V48-3-P217-224.pdf

    Incidentally, in view of what the scientific evidence is telling us about chiropractic, I can’t help but think that the UK College of Chiropractors’ application for a Royal Charter is a little premature. See 5th June 2007 news item here:
    http://www.colchiro.org.uk/default.aspx?m=39&mi=202&ms=0

    (Of course, it could be that the completion of the application process – the granting of a Charter – has been timed to coincide with King Charles III’s arrival on the throne.)

  • 13 NZ Chiropractors vs NZ Medical Journal « Evidence Based Thought // Aug 11, 2008 at 02:14

    […] For more details and posts about the NZMJ legal ”battle” check out this page which seems to be keeping up to date with posts about the issue, and Colquhoun’s own site here. […]

  • 14 Evidence should trump “legal muscle” « Open Parachute // Aug 12, 2008 at 04:53

    […] See also: Chiropractors resort to legal intimidation? Silence Dissent! […]

  • 15 British Chiropractors Join the Legal Intimidation Party « Holford Watch: Patrick Holford, nutritionism and bad science // Aug 17, 2008 at 01:07

    […] Professor David Coluqhoun: Doctor Who? Deception by Chiropractors Chiropractors Resort to Legal Intimidation. […]

  • 16 Chiropractors sue Simon Singh - prefer legal action to evidence « gimpy’s blog // Aug 17, 2008 at 10:27

    […] contained in an article he wrote “Beware the Spinal Trap”.  This follows attempts by chiropactors in New Zealand to sue David Colquhoun after he criticised their lack of evidence in the New Zealand Medical […]

  • 17 Plain speaking: Wellington, Russell and Wakley on managers, reform, medicine and quacks // Aug 18, 2008 at 16:40

    […] post is written in part as a distraction from a plague of lawyers, in New Zealand, here in the UK, and now in the USA (my movie, Integratative baloney@Yale, has recently been […]

  • 18 Jonathan Hearsey » ‘Self-Destructing Chiropractors’ // Aug 19, 2008 at 10:54

    […] DCscience Quackometer […]

  • 19 Dr-star-T // Aug 20, 2008 at 22:24

    Came across this, thought you might be interested as a UK example:
    Chiros not allowed to be called Dr in ads

  • 20 David Colquhoun // Aug 20, 2008 at 23:00

    Dr-star-T, thanks for that really interesting link. Not just titles but also claims for effectiveness with good evidence are ruled to be unacceptable.

    The Advertising Standards Authority has done another good job. The problem is that they have no teeth.

  • 21 Jonathan Hearsey » ‘The Plausibility of CAM on the NHS’ // Aug 21, 2008 at 09:58

    […] Zealand have loaded a legal gun. The BCA and NZCA have their sights set firmly in the direction of eminent commentators, but I wonder if it is their very own feet that are in the crosshairs? The Internet is […]

  • 22 An ex-chiropractor speaks out // Aug 21, 2008 at 11:24

    […] will be interesting to see what happens to the threatened legal action in the light of evidence like this. Now Jonathan has sent a version of his letter that he wishes to […]

  • 23 Back crack quack attack - it’s a legal matter, baby « Dr Aust’s Spleen // Aug 21, 2008 at 22:08

    […] together with an unrepentant re-statement of their main points of issue with the Back-crackers (see David Colquhoun’s blog for details and for links to the articles). More recently, in the UK, the British Chiropractic […]

  • 24 Ben Goldacre and The Guardian triumph over murderous Matthias Rath « gimpy’s blog // Sep 13, 2008 at 12:40

    […] litigious in the face of legitimate criticism.  Examples include chiropactors suing Simon Singh and threatening academic journals, the Society of Homeopaths and discredited tricksters indulging in dirty tricks against the […]

  • 25 Chiropractic wars. Part 3: internecine conflict // Sep 25, 2008 at 09:36

    […] of Gilbey’s paper and my editorial in the New Zealand Medical Journal (NZMJ) led to a threat of legal action by the NZ Chiropractors’ Association Inc for alleged defamation.  After publishing a defiant […]

  • 26 Patent medicines in 1938 and now: A.J.Clark’s book. // Sep 29, 2008 at 22:51

    […] that I wrote for the New Zealand Medical Journal.  That was a little scary, but the journal stuck up for its right to speak and the threat went away after  chiropractors were allowed right of reply (but we got the last […]

  • 27 An ex-chiropractor speaks out: again // Dec 7, 2008 at 17:51

    […] editorial, and in some ways went further.  This letter doubtless contributed to dropping of the threatened legal action by chiropractors against the Journal and against me.  The letter was posted originally on 21 […]

  • 28 It’s quiet…. Too quiet « Dr Aust’s Spleen // Dec 23, 2008 at 23:51

    […] To quote (again) the Editor of the New Zealand Medical Journal, Prof Frank Frizelle, when the New Zealand Chiropractic Association recently threatened to sue him, his journal, and his authors: […]

  • 29 Most alternative medicine is illegal // Jan 15, 2009 at 10:42

    […] about law, I don’t mean lawsuits for defamation.  Defamation suits are what homeopaths and chiropractors like to use to silence critics. heaven knows, I’ve becomes accustomed to being defamed by […]

  • 30 You couldn’t make it up « Dr Aust’s Spleen // Mar 10, 2009 at 00:13

    […] institutionally, as well as individually, thin-skinned – as the BCA vs. Simon Singh libel case, and recent events in New Zealand, show. They also seem to be rather humourless. I started to get this latter idea while reading a […]

  • 31 Alt Med Societies « jdc325’s Weblog // May 21, 2009 at 21:40

    […] actions of the BCA in suing Singh are reminiscent of another case. David Colquhoun was the subject, along with Andrew Gilbey, of legal threats from the New Zealand Chiropractors’ […]

  • 32 The chiroprats strike back « Majikthyse // Jun 7, 2009 at 22:41

    […] especially their use of the title `doctor’. No need for me to repeat the story here, just read it for yourselves. The riposte from the editor of the journal has gone down as a classic – “Let’s […]

  • 33 New Zealand Chiropractors in New Complaint « jdc325's Weblog // Jun 16, 2009 at 16:58

    […] chiropractors in New Zealand are risking further damage to their reputation. Having used legal muscle rather than evidence to respond to criticism in The Journal of the New Zealand Medical Association […]

  • 34 Piers Springthorpe, CHAIRMAN of Merrehill Ltd, Manchester Scientologist - Page 6 - Why We Protest | Activism Forum // Jun 18, 2009 at 16:49

    […] the Scifag playbook when it comes to criticism… Anyone would think they had something to hide… Chiropractors resort to legal intimidation A characteristically amateurish and socially inappropriate approach to pitching an article – Bad […]

  • 35 Zip it, Or We’ll Sue! « Fresh Views From Reality // Jun 20, 2009 at 02:52

    […] editorial response accusing the writer David Colquhon of defamation. *(Mr Colquhon is writer of the DC Science blog). After a complete destruction job of such claims, the NZ Medical Journal’s editor, Professor […]

  • 36 mvp019a // Aug 16, 2009 at 15:32

    http://www.nzma.org.nz/journal/121-1280/3223/

  • 37 David Colquhoun // Aug 16, 2009 at 16:01

    @mvp019a
    The response form “Dr” Brian kelly, to which you refer without comment does little to disguise the fact that chiropractic has next to no evidence base. We can thank Simon Singh for, among other things, prompting a re-examination of what passes for evidence. Perhaps it would have been fairer of you to have linked to all the discussions of chiropractic in the NZMJ

    1.  Editorial: Doctor Who? Inappropriate use of titles by some alternative "medicine" practitioners
    David Colquhoun
    25-Jul-2008 – Vol 121 No 1278 [full text] [PDF]

    2.  Letter: Abuse of the title “Dr”
    Kevin Dew, Andrew Gilbey, David Colquhoun
    08-Aug-2008 – Vol 121 No 1279 [full text] [PDF]

    3.  Editorial: Defamatory articles or not?
    Frank A Frizelle
    08-Aug-2008 – Vol 121 No 1279 [full text] [PDF]

    4.  Letter: Who is confused by courtesy titles?
    Kevin Dew
    22-Aug-2008 – Vol 121 No 1280 [full text] [PDF]

    5.  Letter: Setting the record straight: New Zealand Chiropractors’ Association response
    Simon Roughan
    22-Aug-2008 – Vol 121 No 1280 [full text] [PDF]

    6.  Letter: New Zealand College of Chiropractic response to "Dr Who?" editorial
    Brian Kelly
    22-Aug-2008 – Vol 121 No 1280 [full text] [PDF]

    7.  Letter: A rejoinder to Professor Kevin Dew’s letter “Who is confused by courtesy titles?” and response
    Andrew Gilbey, Kevin Dew
    05-Sep-2008 – Vol 121 No 1281 [full text] [PDF]

    8.  Letter: Colquhoun reply to chiropractic-defending letters from Kelly, Bale, and Roughan and response from NZCA
    David Colquhoun, Simon Roughan
    05-Sep-2008 – Vol 121 No 1281 [full text] [PDF]

  • 38 mvp019a // Aug 16, 2009 at 17:20

    I’m in my third year of pharmacy school – don’t even act like allopathic medicine has their feces together…it doesn’t.

  • 39 David Colquhoun // Aug 16, 2009 at 17:42

    @mvp019a
    Good heavens, I presumed you were a chiropractor. But I’m afraid your syntax has me beaten. If you could explain in English what you are talking about I might be able to reply.

  • 40 mvp019a // Aug 17, 2009 at 14:58

    English = “has their s**t together”

    Oh – you presumed huh? Maybe that’s why you so often come across as an insufferable, overbearing, lout on your posts. Of course, with censorship ability that’s easily accomplished. “You can think anything you want as long as I agree with it…because I’ll have the last word anyway.” Sounds like a Rush Limbaugh approach to dialogue to me.

    The entire US “health care” model is designed to push as many pills as possible into the hands of as many people as possible. It’s a disgrace, and if I weren’t so far in debt for starting line of work this I would quit. They use the “evidence based medicine” excuse to accomplish this – but the studies are mainly designed to sell product in as many ways as possible, and the FDA is Big Pharma’s whore. The whole setup is about who pays the most money to politicians, and patient quality of life be damned. I see WAY too many people on WAY too many medications, half of which are to counteract the side effects of the other medications. Polypharmacy = CVS & Merck’s dream of a perfect world.

    And you think Obama and the government can make health care better? Jesus Christ, the government does NOTHING well. Zero. Zilch. Not a damn thing. And especially not in a cost efficient manner. And I’m supposed to feel good about an organization that can’t even get mail delivery down to manage my health care.

  • 41 David Colquhoun // Aug 17, 2009 at 15:58

    At least we can agree on the corruption of the FDA that was brought about (or at least greatly exacerbated) by G.W, Bush and his anti-science policies. Personally, I much prefer Paul Krugman, but perhaps he isn’t so popular in the southern USA.

    Actually I never censor comments like yours, if only because they are so effective in strengthening my arguments for using evidence and reason. How, I wonder, can it be that the UK gets better health outcomes (at half the cost) if the governments are so incapable?

    Apart from that, perhaps it’s easier to let the readers decide which one of us resembles more closely Rush Limbaugh.

  • 42 mvp019a // Aug 17, 2009 at 21:53

    And how many people live in the UK? Now multiply by 5, and your headaches and administrative issues grow more exponentially than that. I can’t speak to the UK or its people or government. Trust me – the US government will screw it up, like they have everything they have ever touched.

    And the FDA has been for sale LONG before Dubya the Dope was president…Big Pharma $ has been greasing the skids for long before that numbskull took office.

    Not saying the US healthcare system isn’t broken; it is. Change is needed. But letting Uncle run it will guarantee the interests with the most money will get the most from it (even more so than now), and as health care provider and consumer I will lose.

    In America, it somehow has become de rigueur for people to expect health care access to only cost a small amount of money in the form of a co-pay (and in some cases they honestly believe it should be free all of the time.) This situation points to a common prevarication in our current health care paradigm; that it is somehow a “free market” health care system.

    Almost all health care access falls economically into one of 5 categories:

    1. Those who have insurance (whether provided by an employer or self-purchased), and pay only a portion of the cost regardless of what that cost is.
    2. Those who are on some form of government sponsored health care, funded by taxpayer dollars, and only pay a portion (if any) of the cost regardless of the cost.
    3. Those who pay for health care with their own dollars, and bear the whole cost.
    4. Those who have insufficient funds with which to purchase health care or insurance and do without.
    5. Those who partake of health care services, but do not pay because they have nothing to lose by not paying.

    Interestingly, members of all 5 groups contribute to the health care economics of the second and fifth group…the degree of contribution is the only variable. This is of course, accomplished through taxation. Even with the tax, groups 2 and 5 may come out “ahead” because they take out of the system much more than they give. But if one looks at the first group, it can be arguably viewed as a privatized form of socialized medicine, where those in the insurance system pool risk and only those who can afford the “tax” (i.e., the premiums) are able to access health services at what appears to be an affordable scale. The first, second, and fifth groups have little apparent stake in the true cost of healthcare, which they often fail to see as affecting their taxes, whether governmentally imposed or privately imposed in the form of higher premiums (or the hidden tax of inflation, which is how they really finance these programs vis-a-vis the printing press of currency creation.) Therefore there is little impetus in the health care delivery system to control cost, because true free market forces are not brought to bear. Quite simply, it is NOT a free market system as currently constructed.

    PS – I despise Rush Limbaugh – you crack me up…anyone who doesn’t agree with you must be in the Limbaugh-style camp. Far from it, I assure you. I wouldn’t urinate on him if he was on fire.

  • 43 David Colquhoun // Aug 17, 2009 at 22:49

    Ah now you are beginning to talk in coherent sentences I’m beginning to understand a bit better. But you seem to despise almost everyone.

    It seems that we agree that the US system is not at all satisfactory. I know what I’d do out it. Obama knows what wants to do about it. Krugman knows what he wants to do about it. What isn’t at all clear to me is what you want to do about it.

  • 44 mvp019a // Aug 18, 2009 at 02:24

    I don’t despise everybody…just politicians who lie to me and collude to take my money, which I work very hard far…and don’t have that much of. And where is it written that you have to adore either democrats or republicans…especially when the biggest difference between them is the spelling. “Under democracy one party always devotes its chief energies to trying to prove that the other party is unfit to rule – and both commonly succeed, and are right.” H. L. Mencken

    Heath costs began to skyrocket when people began to expect to pay next to nothing to get health care. Let’s return to a more free market approach where a doctor has to be aware of costs. The reason $200 medication is $4 in Cuba (per Michael Moore’s canard of a movie) is because the drug companies are raping the American consumer – the $200 here subsidizes the cost there (and elsewhere.) But the American consumer in many cases doesn’t care about the cost, and is apparently too stupid to see the connection between health care costs and their insurance premiums…all they care about is the $20 copay.

    What about higher deductible plans where you pay for the little stuff yourself and insure against catastrophic illness/accidents. When it is all but free, it is not valued; I see people on Medicaid who are running their kids in for antibiotics almost every time the kid sneezes. Same kids on various antibiotics week in and week out…gee, I wonder where resistance comes from? Public money indeed needs to be there for those who are unable (as opposed to refuse to) help themselves…but when you are looking at third generation Medicaid something is wrong. And the Obama system will only further that.

    Plus, there is one thing that no one is talking about; there is no money for this. Even the mighty American government can’t spend more than it makes forever…at some point the piper must be paid in one way or another. And the citizenry will be the ones to get hurt…not the politicians.

    Anyway, I have to go study; classes began today.

  • 45 Allo V Psycho // Aug 18, 2009 at 16:22

    mvp019a, you seem angry, though at a variety of targets, including Governments, the FDA, media pundits, large health care providers, doctors and the public. Have I missed anyone out? More cogently, have you missed anyone out? Is there anyone you not angry at? However, is that a justification for you to direct personal abuse at DC?

    Some of your anger seems directed at your own Government: “Trust me – the US government will screw it up, like they have everything they have ever touched.” For what it’s worth, I think all large organisations, public or private, are inefficient. But that does not mean they are ineffective. Historically, the US Government has delivered a number of successes, and seems to me to now be attempting to address one of its largest failures – equitable health care. Quite possibly, this would be more cost effective than the current system, and therefore cost less.
    You say “Let’s return to a more free market approach where a doctor has to be aware of costs”. Unfortunately, true free market medicine has a flaw/dilemma – it is in the doctors’ financial interest to treat the healthy wealthy, not the poor old sick, yet they have a moral obligation to treat everyone who is sick. You are therefore right to say that it is necessary to insure against serious health events. Unfortunately, it is also not in the insurance company’s interests to accept poor high risk customers, so again a pure free market system leaves people without any cover, in a world where their health conditions could have been addressed had they the money. The solution is either a State insurance scheme (which is how the NHS started), a regulated private scheme (where companies cannot refuse customers) or a combination of both approaches. The US has gone for the last of these, but one which works in a costly way yet still fails to provide universal coverage. Surely it is worth trying to improve this?
    All health (and social ) systems have a problem with ‘freeloaders’. There is no perfect way of helping what the Victorians thought of as ‘the deserving poor’ – if such a group exists, they cannot readily be distinguished from what you seem to regard as the ‘undeserving’ poor.
    As far as the FDA is concerned, if they are entirely corrupt, why do many of their decisions correspond to those made in systems of socialised medicine? It was the FDA who prevented the release of thalidomide in the UK because of absence of safety data.

    Perhaps, of course, you came here only to vent your anger, rather than to engage in discussion. In that case, I do hope it has helped. Best wishes with your course, which I hope promotes caring and communication skills, an ability to assess evidence rationally, and an appreciation of patient and societal well being, during your remaining studies.

  • 46 Allo V Psycho // Aug 18, 2009 at 16:23

    Sorry, should have said “It was the FDA who prevented the release of thalidomide in the US “

  • 47 mvp019a // Aug 18, 2009 at 22:24

    Oh I have nearly no use for the US government – these people are no longer “public servants”, but almost to a man (and woman) are self-serving, greedy, corrupt, liars. I’ll quote Mencken again: “Every decent man is ashamed of the government he lives under.” – I so wish he has been alive and writing during this and the past few administrations – would have been fun reading!

    back to the original topic on chiropractic; my mother years ago went to Ireland for vacation, and slipped on some castle stairs (stone) and bumped down a fair number of them on her bum. She went to an MD, who of course whipped out the old anti-inflammatory (OK), pain pills, and mm. relaxers trio. Then sent her for many months of physical therapy. She would feel OK right after the PT, but within a day, in pain again. This persisted for about 7-8 months until they said that there was nothing they could do for her. A friend recommended her to a DC, and in 3 visits (about a week) she was pain free and hasn’t had any problems since, and that has been well over 10 (probably more like 15) now. What am I supposed to say about that? Obviously, the chiropractor addressed some biomechanical anomaly that traditional medicine did not. Or am I supposed to tell her that it was all in her head and the affect was strictly placebo? That seems rather silly. I know it is an anecdotal case, but if I were her I would be pretty convinced as to what helped me and what didn’t.

    I have been involved myself in competitive athletics (ice hockey, powerlifting) in my younger days, and I used a chiropractor – it helped me stay in the game when I would otherwise have had to not play/compete. My first lifting injury I went to a MD, got the big trio (as described above) and was told to give up weight lifting. (At the ripe old age of 24.) That’s what prompted me to try a chiropractor – my thought was “I’m only 24, why should I have to quit something I like doing at such a young age – in what should be my athletic prime.” So I went to a DC recommended by a friend, and went from being unable to stand up straight to setting personal records in the squat & deadlift at a meet a week or so later…a meet I thought I was going to have to miss.

    Only anecdotes, but certainly not placebo. And in conjunction with rational pharmaceutical care, I believe useful for many musculo-skeletal conditions.

  • 48 David Colquhoun // Aug 19, 2009 at 21:23

    @mvp019a
    I’m afraid that belief is all that have. The evidence simply isn’t there. Since you like H.L. Mencken, how about

    “Faith may be defined briefly as an illogical belief in the occurrence of the improbable.”

    Or perhaps, given the plumb crazy ideas of the founder of chiropractic, this

    “There is always a well-known solution to every human problem–neat, plausible, and wrong.”

    I know from personal experience how very variable back pain can be. May I suggest that you read a bit about ‘regression to the mean’.

  • 49 mvp019a // Aug 20, 2009 at 06:44

    Joint not moving or moving dysfunctionally = pain and inability to compete.

    Joint moving freely and functioning as intended = absence of pain and ability to be athletically active.

    Is that really so hard to comprehend from a physiological and biomechanical standpoint? I could feel the damn thing (my sacroiliac joint) was “stuck”…not moving. After his manipulation, it was ,moving again, and I could stand normally. It wasn’t like the guy kept me coming back forever. Probably treated me 5 times, and that with me still training as best I could, which wasn’t helping matters any. And believe me, I was about as intrepid & skeptical as I could be when I went there.

    My chiropractor had no use for the rantings of the Palmers…near as I could tell he had nothing in common with them, because I asked him about where it came from. He thought the whole story about the deaf guy was bullcrap, and derided about 70% of the profession. His whole premise was joint function vs. dysfunction.

    But I’ll be sure and tell my mother she’s still in pain, but just doesn’t realize it…or that 8 months of ineffectual PT suddenly manifested itself successfully a week or 2 later in shear coincidence with a few visits to a chiropractor.

  • 50 Allo V Psycho // Aug 20, 2009 at 10:26

    Well, perhaps they don’t teach you about analysing evidence in US pharmacy schools, though I know they do in the UK. There are a variety of reasons why anecdotes are not evidence. Some of these have been mentioned already. Some conditions alleviate spontaneously with time (back pain is one, as I can also attest). Some cyclic conditions show regression to the mean. Some conditions are responsive to placebos, which does not mean that they were not real, nor even that they are not improved. But there is another class of reason which I don’t recall seeing discussed here, and it is to do with narrative structure. Humans are story-telling animals, and often impose a narrative form on events. These structures feature heroes, villains and victims; unexpected turns; the triumph of hope over expectation, and so on. I certainly do this to events in my past. I still tell anecdotes from my University days, and recently had the salutory experience of finding my diary from that time. I was astonished and dismayed to note how different events were as seen at the time, from my long-practiced re-telling. And even at the time I might have seen them incorrectly!
    Now, I am not saying that you are a liar, by any means. But do you agree that it’s possible people might ‘smooth off’ stories in the retelling? And when you are using your stories to support a position in argument, the temptation to ‘smooth off’ becomes even stronger.
    If you can admit that this could happen (even if you are adamant that it has not happened with you!), can you see that it means that you cannot rely on other people’s anecdotes as evidence? So your anecdote is not evidence for anyone else, and you too should be most cautious in accepting it.
    Science (as Lewis Wolpert said) is unnatural. It requires you, formally, to design experiments to disprove your cherished ideas. That is why it has been succesful. Story-telling is natural to humans, and we managed to demonstrate over millenia that it was a very poor way to make progress. Can you appreciate that a double blind randomised controlled trial is worth more than all the stories in the world?

  • 51 Dr Aust // Aug 20, 2009 at 11:51

    Allo V wrote:

    Humans are story-telling animals, and often impose a narrative form on events. These structures feature heroes, villains and victims; unexpected turns; the triumph of hope over expectation, and so on.

    Quite. Reminds me of Prof Paul Offit’s oft repeated line about why he refuses to “debate” Antivax poster girl Jenny McCarthy on Oprah, or elsewhere on US TV:

    “Every story has a hero, victim, and villain. McCarthy is the hero, her child is the victim—and that leaves one role for you.”

  • 52 mvp019a // Aug 20, 2009 at 13:51

    Sorry to disappoint – those events are factually related here. And yes – they do teach the evidence based approach, and I understand why, both to the good and the bad.

    Of course, God help the patients who aren’t close to the center of the bell curve, because by the time your “cookbook” approach physician figures out you are more than a standard deviation or two from the median, you’ll be dead.

  • 53 David Colquhoun // Aug 20, 2009 at 18:28

    Allo V Psycho
    You put the ‘narrative argument’ more clearly and elegantly than I have seen before. Thank you very much

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