Tag Archives: Evidence based

Is Chiropractic Really Scientific?

The scientific method is the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses.

With Chiropractic we recognize a problem when you come into our office in pain, we collect data through observation, taking a history, and testing. We then form a hypothesis and call it a differential diagnosis. We apply treatments that have either worked in the past for similar conditions or we suspect will work based upon our knowledge and understanding of the human body. If treatment does not provide results we acknowledge the lack of results and re-assess our hypothesis, and present additional treatments or referral.

The question implies an additional question; is chiropractic backed by solid evidence? This is a harder question. Only between 10-20% of all medical treatments are actually supported by solid evidence, according to Dr. David Sackett founder of the Oxford Center for Evidence-Based Medicine. This isn’t to say that only 2 in 10 people get evidence based care. There are thousands of treatments out there, and only a hundred or so are commonly used. Dr. Sackett guessed that, more than 20%of all treatments rendered were based on evidence. But he was unable to say how much more.

A recent study on the same topic found:

“…When compared to the many other studies of similar design that have evaluated the extent to which different medical specialties are evidence based, chiropractic practice was found to have the highest proportion of care (68.3%) supported by good-quality experimental evidence.” (source)

Chiropractic is relatively new on the scene as an organized profession, and has had to battle it’s way into the mainstream. As a consequence of this, more studies have been done on chiropractic treatments than many of the common medical treatments for the same conditions.

“There are considerably more randomized controlled trials which show benefit of Chiropractic than there are for many, many other things which physicians and neurosurgeons do all the time.”—Paul G. Shekelle, M.D., M.P.H., of the RAND Corporation, interviewed on ABC’s 20/20

So… by this evidence, chiropractic could be considered to be the most scientific health care profession.

Accepted Therapies – What Research?

JMPTIn a review of research on the topic of evidence it was reported that about 75-85% of all medical treatments are evidence based.  In this review, evidence based included non-experimental evidence most often reported to mean unanimity among physicians that there was convincing non-experimental evidence.  Only about 30-40% of all treatments in these studies were based on Randomized Controlled Trials (RCTs).  Here is another similar review with citations.

There are levels of quality in evidence. RCTs are currently held as the gold standard of evidence, but some treatments don’t lend themselves to testing in this manner or are common sense.  Even in RCTs there are always outliers that don’t conform.  If we could do an RCT for every treatment that would be great, but we can’t.  Evidence based treatment relies on doctors to make the best decisions based on all the evidence available to them at the time.  JCMSo I’d say that 85% of medical treatments are based on evidence and a judgment call. That, is good.

There does seem to be a double standard in this area of discussion.  When it comes to traditional medicine the levels of accepted evidence are understood.  When it comes to complimentary and alternative treatments (CAM) anything less than an RCT is refused as evidence.  Because of this bias chiropractic has been forced to prove it’s self by performing RCTs.  And research has now found about 68% of all chiropractic procedures are backed by RCTs.  Compared to 30-40% of medical treatments.  That is also good.

I appreciate having good research to support my profession.  I’d really like to stop hearing that chiropractic is not founded in evidence, but that may not happen.  On a slight tangent, and to give you a thought provoking sampling, here are a few common treatments that either have limited evidence or research that actually finds that they don’t help.