Dude, how do you double blind a chiropractic treatment? It's very very difficult. What is the placebo for this trial? Again, this is a tricky ariiea and most current options are rrelatively poor. I research placebo and the only areas where we have good enough processes to disentangle placebo and real treatment is with pills freaks and injections. Anything else is pretty hit or miss. I'm not saying that chiropracty works, just that we have no good way of seperating the expectation effects from the 'real' effects.
A typical patient has no idea about the precise nature of the manipulations that are to be used - location, intensity, type of manipulation and so on. For chiropractic to be valid they need to be able to prescribe a specific treatment to a specific condition for a patient. If the prescription is valid then if the patient undergoes a different manipulation it shouldn't have the same effect. If it does then the idea that it was that specific manipulation is potentially invalidated.
You could actually even double blind it by having one chiropractor diagnose and prescribe treatment, and then have that treatment randomised so it was either done as prescribed or substituted for a sham treatment. That treatment would then be administered by a second chiropractor who was unaware of the diagnosis and not allowed to speak to the patient about it or modify the treatment.
Even if that was too complex or otherwise flawed a properly constructed single blinded RCT trial is still valid evidence, even if it's not the best of the best.
Comments
Dude, how do you double blind a chiropractic treatment? It's very very difficult. What is the placebo for this trial? Again, this is a tricky ariiea and most current options are rrelatively poor. I research placebo and the only areas where we have good enough processes to disentangle placebo and real treatment is with pills freaks and injections. Anything else is pretty hit or miss. I'm not saying that chiropracty works, just that we have no good way of seperating the expectation effects from the 'real' effects.
A typical patient has no idea about the precise nature of the manipulations that are to be used - location, intensity, type of manipulation and so on. For chiropractic to be valid they need to be able to prescribe a specific treatment to a specific condition for a patient. If the prescription is valid then if the patient undergoes a different manipulation it shouldn't have the same effect. If it does then the idea that it was that specific manipulation is potentially invalidated.
See: http://www.ncbi.nlm.nih.gov/pubmed/10519559
You could actually even double blind it by having one chiropractor diagnose and prescribe treatment, and then have that treatment randomised so it was either done as prescribed or substituted for a sham treatment. That treatment would then be administered by a second chiropractor who was unaware of the diagnosis and not allowed to speak to the patient about it or modify the treatment.
Even if that was too complex or otherwise flawed a properly constructed single blinded RCT trial is still valid evidence, even if it's not the best of the best.